CASE PRESENTATION UB.......................pptx

CASE PRESENTATION
Dr. Gayatri Sahu

 The patient is 62 years male.
 USG showed stone in urinary bladder ,
with no obvious growth.

 Prostatic chips had been sent for
histopathology.

The 2016 WHO Classification of
tumors of Urothelial tract .

Papillary Urothelial
Carcinoma
Macroscopic Appearances:
 Some are barely visible small papillary
excrescences whereas others are huge
masses of confluent papillary tissue that
may have a “cauliflower-like” appearance
almost filling the bladder lumen.
 They are typically soft, delicate, and friable.

Microscopic findings
 Complex branching pattern
 The papillae are usually covered by
more than seven layers of cells.
 Cytologic atypia present.
 Atypical mitosis may b present

 Papillary carcinomas are graded by
using cytologic and architectural criteria,
and this has major prognostic
significance.
 A system of three categories is widely
recommended and generally used.

 PAPILLARY UROTHELIAL NEOPLASM OF LOW
MALIGNANT POTENTIAL
 LOW-GRADE PAPILLARY CARCINOMA
 HIGH-GRADE PAPILLARY CARCINOMA

PAPILLARY UROTHELIAL
NEOPLASM OF LOW MALIGNANT
POTENTIAL
 Papillae usually covered by a thickened
epithelium.
 The cells are normally oriented and
show mild degrees of nuclear
enlargement and hyperchromasia.
 Mitoses are infrequent and basally
located if present.
 Apoptotic bodies rarely seen.
 Invasion is infrequent.

LOW-GRADE PAPILLARY
CARCINOMA
 Branching papillae, fused and delicate.
 Predominantly ordered, yet minimal
crowding and minimal loss of polarity;
any thickness; cohesive.
 Enlarged round to oval nucleus with
variation in size and shape.
 Mitosis - occasional, at any level.

HIGH-GRADE PAPILLARY
CARCINOMA
 Papillae are fused, branching.
 Predominantly disordered with frequent
loss of polarity; any thickness; often
discohesive.
 Nucleus - enlarged , hyperchromatic
with moderate–marked pleomorphism.
 Multiple prominent nucleoli .
 Mitosis- Usually frequent, at any level with
abnormal mitotic forms.

Local spread and metastases
 Assessment of invasion in cases of papillary
carcinoma may be difficult.
 Tangential sectioning of the bases of papillae
may simulate invasion by giving the
appearance of detached nests of cells in the
lamina propria.
 Most crucial to prognosis is the presence or
absence of invasion of the muscularis propria.

 Invasive bladder carcinomas (especially
high-grade tumors) are associated with
zones of atypical proliferation,
carcinoma in situ, and early invasive
carcinomas in areas remote from the
main tumor mass.

 Bladder carcinoma may extend into the
neck of the bladder, urethra, prostatic
ducts, and seminal vesicle;
more commonly than to the ureters.
 Lymph node metastases in the pelvic
chains are found in 25% of the invasive
tumors.
 Distant metastases seen in lungs, liver,
bone, and central nervous system.

To differentiate between high-grade
malignant tumor for which the differential
diagnosis is between urothelial and
prostatic carcinoma:
 CK34ßE12, CK7, P53 = positive in
urothelial carcinoma.
 PSA, PSAP, and Leu7(CD57) = positive in
prostatic carcinoma.
 This panel of six markers is essential to
differentiate.

The selection of the antibody panel to use
in a given case depends to a large extent
on the differential diagnosis being
considered
1.Urothelial carcinoma with inverted
growth pattern versus inverted
papilloma:
 Ki-67,
 P53 and
 CK20
(all of them usually positive in the former)

2. High-grade urothelial carcinoma versus
poorly differentiated prostatic
adenocarcinoma:
 CK34ßE12 and p63 (positive in the
former), and
 PSA (positive in the latter)

3. Metastatic micropapillary urothelial
carcinoma of prostate versus
micropapillary carcinoma of other sites:
 uroplakin,
 CK20,
 TTF-1, and
 hormone receptors

 The pathology report of a bladder biopsy that
contains a tumor should include the following
information:
1 Grade
2 Configuration (papillary or solid)
3 Depth of penetration
4 Presence of muscle
5 Lymphatic invasion
6 Blood vessel invasion
7 Changes in adjacent mucosa if present

CASE PRESENTATION UB.......................pptx

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CASE PRESENTATION UB.......................pptx