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Questions and Answers
What is a characteristic morphology of Urothelial Papilloma?
What is a characteristic morphology of Urothelial Papilloma?
Which of the following tumors is considered a low-grade non-invasive condition?
Which of the following tumors is considered a low-grade non-invasive condition?
What is a significant risk factor for tumors of the urinary bladder?
What is a significant risk factor for tumors of the urinary bladder?
What is the typical age range for patients with Urothelial Papilloma?
What is the typical age range for patients with Urothelial Papilloma?
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What is the expected 5-year survival rate for patients with ureteric carcinoma?
What is the expected 5-year survival rate for patients with ureteric carcinoma?
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Inverted Urothelial Papilloma typically displays which morphological feature?
Inverted Urothelial Papilloma typically displays which morphological feature?
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Which mutation is associated with the pathogenesis of Urothelial Papilloma?
Which mutation is associated with the pathogenesis of Urothelial Papilloma?
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What clinical symptom is commonly associated with tumors of the urinary bladder?
What clinical symptom is commonly associated with tumors of the urinary bladder?
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What is the main histological feature of inverted urothelial papilloma?
What is the main histological feature of inverted urothelial papilloma?
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Which mutations are associated with the pathogenesis of papillary urothelial neoplasm of low malignant potential?
Which mutations are associated with the pathogenesis of papillary urothelial neoplasm of low malignant potential?
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What age group is primarily affected by non-invasive papillary urothelial carcinoma, low-grade?
What age group is primarily affected by non-invasive papillary urothelial carcinoma, low-grade?
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What is a common risk factor for developing non-invasive papillary urothelial carcinoma, low-grade?
What is a common risk factor for developing non-invasive papillary urothelial carcinoma, low-grade?
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Which of the following features is NOT characteristic of inverted urothelial papilloma?
Which of the following features is NOT characteristic of inverted urothelial papilloma?
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What histological characteristic can be found in non-invasive papillary urothelial carcinoma, low-grade?
What histological characteristic can be found in non-invasive papillary urothelial carcinoma, low-grade?
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How would you describe the cystoscopic appearance of inverted urothelial papilloma?
How would you describe the cystoscopic appearance of inverted urothelial papilloma?
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What immunohistochemical marker is positive in inverted urothelial papilloma?
What immunohistochemical marker is positive in inverted urothelial papilloma?
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What is a common risk factor for invasive urothelial carcinoma?
What is a common risk factor for invasive urothelial carcinoma?
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Which immunohistochemical marker is typically negative in pure squamous cell carcinoma of the urinary bladder?
Which immunohistochemical marker is typically negative in pure squamous cell carcinoma of the urinary bladder?
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What morphological feature distinguishes pure squamous cell carcinoma of the urinary bladder?
What morphological feature distinguishes pure squamous cell carcinoma of the urinary bladder?
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Which statement regarding adenocarcinoma of the urinary bladder is incorrect?
Which statement regarding adenocarcinoma of the urinary bladder is incorrect?
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Invasive urothelial carcinoma is characterized by which of the following growth patterns?
Invasive urothelial carcinoma is characterized by which of the following growth patterns?
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What is a common finding in the gross morphology of pure squamous cell carcinoma of the urinary bladder?
What is a common finding in the gross morphology of pure squamous cell carcinoma of the urinary bladder?
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Which mutation is most commonly associated with the pathogenesis of invasive urothelial carcinoma?
Which mutation is most commonly associated with the pathogenesis of invasive urothelial carcinoma?
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Which type of carcinoma shows positive immunohistochemical staining for CK20 and CDX2?
Which type of carcinoma shows positive immunohistochemical staining for CK20 and CDX2?
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What characterizes the morphology of high-grade non-invasive papillary urothelial carcinoma?
What characterizes the morphology of high-grade non-invasive papillary urothelial carcinoma?
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Which cytological feature is typical in high-grade non-invasive papillary urothelial carcinoma?
Which cytological feature is typical in high-grade non-invasive papillary urothelial carcinoma?
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What risk factors are associated with high-grade non-invasive papillary urothelial carcinoma?
What risk factors are associated with high-grade non-invasive papillary urothelial carcinoma?
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What is a characteristic prognosis for patients with high-grade non-invasive papillary urothelial carcinoma?
What is a characteristic prognosis for patients with high-grade non-invasive papillary urothelial carcinoma?
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What is the primary morphological feature distinguishing urothelial carcinoma in-situ from high-grade non-invasive papillary urothelial carcinoma?
What is the primary morphological feature distinguishing urothelial carcinoma in-situ from high-grade non-invasive papillary urothelial carcinoma?
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What variant of urothelial carcinoma in-situ involves single cells growing in a pagetoid manner?
What variant of urothelial carcinoma in-situ involves single cells growing in a pagetoid manner?
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Which immunohistochemistry marker is positive in both high-grade non-invasive papillary urothelial carcinoma and urothelial carcinoma in-situ?
Which immunohistochemistry marker is positive in both high-grade non-invasive papillary urothelial carcinoma and urothelial carcinoma in-situ?
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What is a primary genetic alteration associated with the pathogenesis of non-invasive papillary urothelial carcinoma?
What is a primary genetic alteration associated with the pathogenesis of non-invasive papillary urothelial carcinoma?
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Study Notes
Tumors of Urinary Bladder and Urothelial Tract
- The WHO 2022 classification of urinary and male genital tumors (5th edition) is organized by tumor lineage.
- Urothelial tumors are a key category.
- Squamous cell neoplasms are another key category.
- Glandular neoplasms are also a key category.
- Urachal and diverticular neoplasms are another category.
- Urethral neoplasms are a category.
- Tumors of the Müllerian type are a category.
Objectives
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Urothelial Tumors:
- Urothelial Papilloma
- Inverted Urothelial Papilloma
- Papillary Urothelial Neoplasm of Low Malignant Potential.
- Non-invasive Papillary Urothelial Carcinoma, Low-grade.
- Non-invasive Papillary Urothelial Carcinoma, High-grade.
- Urothelial Carcinoma In-situ.
- Invasive Urothelial Carcinoma, Conventional Type.
- Pure Squamous Cell Carcinoma of Urinary Bladder
- Adenocarcinoma, NOS of Urinary Bladder
Clinical Features
- Clinical: Painless hematuria is a common symptom.
- Affected individuals are typically aged 50-70, with men three times more likely to be affected than women.
- Risk factors: Smoking, industrial solvents, hydrocarbons, dyes, Cystitis, Schistosomiasis, and drugs like Cyclophosphamide.
Clinical (Continued)
- Clinical: High recurrence rate is common.
- Clinical: Fatal cases frequently involve ureteric obstruction.
- Clinical: Overall 5-year survival is 57%.
- Clinical: Five-year survival for ureteric carcinoma is 10%.
Urothelial Papilloma - Morphology
- Morphology: Solitary, exophytic, with thin fibrovascular cores lined by normal urothelium (4-7 layers, normal thickness) without cytologic atypia.
- Morphology: Non-branching, non-fused papillae, sometimes with ballooning of umbrella cells.
Other High Yield Points
- Benign: Age range: 8-87 years, majority in the 5th decade, more common in males.
- Benign: Locations: Trigone, other areas; Size: 2–3 cm typically.
- Pathogenesis: HRAS, KRAS mutations are often involved.
- Gross: Polypoid/papillary is a common appearance.
- Differential Diagnosis: Polypoid/papillary cystitis (broad edematous core, inflammation) may overlap.
- IHC: Positive for CD44 (basal cells) and CK20 (umbrella cells), like normal urothelium.
Inverted Urothelial Papilloma - Morphology
- Morphology: Inverted/endophytic pattern, anastomosing and proliferating cords of urothelial cells.
- Morphology: Cells maintain polarity, palisaded basal cells border cords, surrounding central streaming urothelial cells, and normal thickness.
- Morphology: No atypia is present.
Other High Yield Points (Continued)
- Benign: Age range: any age.
- Location: Bladder neck, trigone, renal pelvis, ureter, urethra,
- Gross: Polypoid
- Pathogenesis: Mutations in HRAS and KRAS genes.
- Differential Diagnosis: Other inverted papillary tumors such as LGPUC, HGPUC, invasive urothelial carcinoma.
- IHC: Positive for CD44 (basal cells). Negative for CK20, p53.
Papillary Urothelial Neoplasm of Low Malignant Potential - Morphology
- Morphology: Papillary architecture, fibrovascular cores lined by thickened urothelium.
- Morphology: Mild cytologic atypia (monotonous appearing cells with mild nuclear enlargement).
- Morphology: Not appreciable at low magnification of the tissue.
- Morphology: No marked cytologic atypia is easily appreciated at low magnification.
Other High Yield Points (Continued)
- Age group: 6th-7th decades, more frequent in males than females.
- Pathogenesis: Some cases with TERT promoter and FGFR3 mutations may be involved; not fully known.
- Cystoscopy: Papillary lesion, small and solitary.
- Gross: Papillary lesion.
- IHC: Not useful for diagnosis.
Non-Invasive Papillary Urothelial Carcinoma, Low-Grade - Morphology
- Morphology: Papillary architecture, fibrovascular cores lined by urothelial cells of variable thickness
- Morphology: With or without mild cytologic atypia (mild nuclear enlargement, hyperchromasia, and size variation), with a mild loss of polarity
- Morphology: Not appreciable at low magnification
- Morphology: No marked cytologic atypia appreciated at low magnification
- Morphology: Mitosis mostly basal
- Morphology: Inverted variant with an inverted growth pattern.
Other High Yield Points (Continued)
- Risk factors: Smoking and chemical exposure.
- Pathogenesis: FGFR3 alterations and TERT promoter mutations may be involved.
- Cystoscopy/Gross: Exophytic papillary tumor, single or multiple, variable size. It's less translucent than LG.
- Prognosis: Frequent recurrence (50%), rare progression to invasive urothelial carcinoma.
- IHC: Not useful.
Non-Invasive Papillary Urothelial Carcinoma, High Grade-Morphology
- Morphology: Papillary architecture, fibrovascular cores lined by urothelial cells.
- Morphology: Marked cytologic atypia including nuclear enlargement, hyperchromasia, prominent nucleoli, and irregular contours.
- Morphology: Loss of polarity/disordered architecture; easily appreciable at low power.
- Morphology: Frequent mitosis, including atypical forms.
- Morphology: More complex and fused papillae compared to LGPUC.
- Morphology: High grade features in at least 5% of total tumor.
- Morphology: Inverted variants with inverted growth pattern.
Other High Yield Points (Continued)
- Mean age: 70 years, more frequent in males than females (3:1).
- Risk factors: Smoking and chemical exposure.
- Pathogenesis: TERT promoter mutations, FGFR3 alterations, and p53 mutations
- Cystoscopy: Exophytic papillary tumor, single or multiple, variable in size, less translucent than LG.
- Prognosis: Frequent recurrence (60%), progression to invasive urothelial carcinoma (25%).
- IHC: CK20 (full thickness), increased Ki67; Negative CD44
Urothelial Carcinoma In Situ - Morphology
- Morphology: Flat lesion with variable thickness; markedly atypical urothelial cells.
- Morphology: Disordered architecture/loss of polarity.
- Morphology: No papillary architecture.
- Morphology: Variants include: Pagetoid (single cells), clinging (mostly denuded).
- Morphology: Glandular variants also exist.
Other High Yield Points (Continued)
- Affects elderly: Affects older patients.
- Pathogenesis: TERT promoter and p53, DNA damage genes, PI3K and MAPK pathways are involved.
- Cystoscopy: Erythematous mucosal patches, difficulty in identification. It can be multifocal.
- Prognosis: Frequent recurrence and progression to invasive urothelial carcinoma is common.
- Differential Diagnosis: Urothelial dysplasia (cytologic atypia of a neoplastic process).
- FISH: Urovision chromosomes 3, 7, 17, 9p21 are involved.
- IHC: Not necessary in classic cases.
- IHC Positive: CK20 (full thickness), p53, increased Ki67
- IHC Negative: CD44 (or decreased)
Invasive Urothelial Carcinoma, Conventional Type - Morphology
- Morphology: Nests, sheets, cords, or single cells that invade lamina propria and beyond.
- Morphology: Mixed architectural patterns; variation in appearance.
Other High Yield Points (Continued)
- Age: Seventh decade or later commonly, 4 males for every 1 female
- Locations: Urinary bladder, upper urinary tract (renal pelvis, ureter)
- Risk Factors: Smoking, radiation, chemicals (benzidine dyes, opiates), high socioeconomic status
- Pathogenesis: TERT promoter mutations, TP53 mutations, others
- Gross: Sessile, ulcerated, polypoid, or papillary
- IHC Positive: GATA3, HMWCK, CK7, CK20, p63, uroplakin.
- Negative: PAX8
Pure Squamous Cell Carcinoma of Urinary Bladder - Morphology
- Morphology: Pure squamous morphology (100%) with the presence of intercellular bridges, keratin pearls, and keratinized cells.
- Morphology: Should not contain conventional UC (urothelial cell carcinoma).
Other High Yield Points (Continued)
- Risk factors: Indwelling catheter (>10 years), bladder stones, smoking, Schistosoma haematobium infection.
- Pathogenesis: Chronic inflammation, loss of chromosomes 17q and 18p in cases associated with Schistosoma.
- Gross: Large, solid, polypoid, nodular, or ulcerated.
- Prognosis: Worse than conventional types
- IHC Positive: CK5, CK6, p63, desmoglein 3
- IHC negative: Uroplakins.
Adenocarcinoma, NOS of Urinary Bladder - Morphology
- Morphology: Pure (100%) adenocarcinoma morphology.
- Morphology: Various patterns may be seen, including enteric/colonic type, mucinous, signet ring cell, or mixed.
- Morphology: Should not contain conventional UC.
Other High Yield Points (Continued)
- Occurrence: Rare (2%), peak in the 7th decade.
- Locations: Urinary Bladder, renal pelvis, ureter.
- Pathogenesis: Unknown; chronic irritation is suspected
- Gross: Single, sessile, nodular, ulcerated
- IHC Positive: CK20, CDX2, Villin, (+/-) CK7, nuclear beta-catenin
- IHC Negative: GATA3 (can be positive, sometimes)
Urothelial Carcinoma of Ureter and Renal Pelvis - Description
- Urothelial carcinoma of the ureter and renal pelvis are variations in disease location.
Conclusion- Summary of Urothelial Tumors
-
Urothelial Tumors:
- Urothelial Papilloma
- Inverted Urothelial Papilloma
- Papillary Urothelial Neoplasm of Low Malignant Potential.
- Non-invasive Papillary Urothelial Carcinoma, Low-grade.
- Non-invasive Papillary Urothelial Carcinoma, High-grade.
- Urothelial Carcinoma In-situ.
- Invasive Urothelial Carcinoma, Conventional Type.
- Pure Squamous Cell Carcinoma of Urinary Bladder
- Adenocarcinoma, NOS of Urinary Bladder
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Description
Explore the WHO 2022 classification of tumors in the urinary bladder and urothelial tract. This quiz covers various types of tumors including urothelial, squamous cell, and glandular neoplasms. Test your knowledge on the clinical features and classifications of these tumors.
