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Pathology - Urothelial carcinomas
Definition • A category of neoplasms originating in the urothelial tract. Equivalent term • Transitional cell carcinomas.
Epidemiology • Prevalent with more than 250,000 new cases globally. • Can manifest throughout the urothelial system, with the predominant occurrence in the bladder, followed by the renal pelvis and ureters (50:3:1, respectively).
Bladder tumors are likely more prevalent because to carcinogens traversing the urine tract residing in the bladder for extended periods.
Aetiology • Tobacco consumption through cigarettes. • Professional exposure to aromatic amines. Genetics • Non-invasive low-grade papillary urothelial carcinomas exhibit little genetic modifications, with the predominant change being deletions of chromosome 9. Non-invasive high-grade papillary urothelial carcinomas, urothelial carcinoma in situ, and infiltrating urothelial carcinomas exhibit genetic instability characterized by several chromosomal aberrations, including mutations in TP53 and RB genes.
Presentation: • The majority present with hematuria.
Macroscopy Non-invasive papillary tumors often develop as frond-like projections from the urothelial mucosa. Infiltrating urothelial carcinomas generally present as solid masses that invade adjacent tissues. Urothelial carcinoma in situ is a flat lesion that may be macroscopically undetectable or present as an erythematous mucosal region.
Urinary cytopathology • Insufficient sensitivity in detecting low-grade urothelial carcinomas. • Proficient in identifying high-grade lesions characterized by significantly abnormal urothelial cells exhibiting big pleomorphic nuclei with black, coarsely granular chromatin. Histopathology Non-invasive low-grade papillary urothelial carcinoma consists of slender papillae bordered by urothelium with minor disorganization and low-grade nuclear atypia. Non-invasive high-grade papillary urothelial carcinoma consists of branching, fused papillae bordered by urothelium exhibiting significant disorganization and pronounced nuclear atypia.
Urothelial carcinoma in situ is a planar lesion characterized by distinctly high-grade nuclear atypia in the urothelium. Infiltrating urothelial carcinoma is a urothelial tumor that has breached the basement membrane. This group is not officially categorized into low and high grade, however the majority have high-grade nuclear atypia.
Prognosis: All have a propensity for multifocality and recurrence. Non-invasive low-grade papillary urothelial carcinomas present a minimal risk of progression to invasion and mortality (<5%). non-invasive high-grade papillary urothelial carcinomas and carcinoma in situ possess a significantly elevated risk of progression. the prognosis infiltrating primarily depends on stage disease. lymphovascular invasion is an unfavorable prognostic indicator.< />pan>
TNM 7 pathological staging of bladder carcinomas
Primary tumour (T)
pTa: non-invasive tumour.
pT1: tumour invades the lamina propria.
pT2: tumour invades the muscularis propria.
pT3: tumour invades perivesical tissue.
pT4: tumour invades adjacent organs (prostate, uterus, vagina, pelvic wall).
Regional lymph nodes (N)
pN1: single positive node in the primary drainage region.
pN2: multiple positive nodes in the primary drainage region.
pN3: common iliac node involvement.
TNM 7 pathological staging of renal pelvis and ureter
carcinomas
Primary tumour (T)
pTa: non-invasive tumour.
Definition • A category of neoplasms originating in the urothelial tract. Equivalent term • Transitional cell carcinomas.
Epidemiology • Prevalent with more than 250,000 new cases globally. • Can manifest throughout the urothelial system, with the predominant occurrence in the bladder, followed by the renal pelvis and ureters (50:3:1, respectively).
Bladder tumors are likely more prevalent because to carcinogens traversing the urine tract residing in the bladder for extended periods.
Aetiology • Tobacco consumption through cigarettes. • Professional exposure to aromatic amines. Genetics • Non-invasive low-grade papillary urothelial carcinomas exhibit little genetic modifications, with the predominant change being deletions of chromosome 9. Non-invasive high-grade papillary urothelial carcinomas, urothelial carcinoma in situ, and infiltrating urothelial carcinomas exhibit genetic instability characterized by several chromosomal aberrations, including mutations in TP53 and RB genes.
Presentation: • The majority present with hematuria.
Macroscopy Non-invasive papillary tumors often develop as frond-like projections from the urothelial mucosa. Infiltrating urothelial carcinomas generally present as solid masses that invade adjacent tissues. Urothelial carcinoma in situ is a flat lesion that may be macroscopically undetectable or present as an erythematous mucosal region.
Urinary cytopathology • Insufficient sensitivity in detecting low-grade urothelial carcinomas. • Proficient in identifying high-grade lesions characterized by significantly abnormal urothelial cells exhibiting big pleomorphic nuclei with black, coarsely granular chromatin. Histopathology Non-invasive low-grade papillary urothelial carcinoma consists of slender papillae bordered by urothelium with minor disorganization and low-grade nuclear atypia. Non-invasive high-grade papillary urothelial carcinoma consists of branching, fused papillae bordered by urothelium exhibiting significant disorganization and pronounced nuclear atypia.
Urothelial carcinoma in situ is a planar lesion characterized by distinctly high-grade nuclear atypia in the urothelium. Infiltrating urothelial carcinoma is a urothelial tumor that has breached the basement membrane. This group is not officially categorized into low and high grade, however the majority have high-grade nuclear atypia.
Prognosis: All have a propensity for multifocality and recurrence. Non-invasive low-grade papillary urothelial carcinomas present a minimal risk of progression to invasion and mortality (<5%). non-invasive high-grade papillary urothelial carcinomas and carcinoma in situ possess a significantly elevated risk of progression. the prognosis infiltrating primarily depends on stage disease. lymphovascular invasion is an unfavorable prognostic indicator.< />pan>
TNM 7 pathological staging of bladder carcinomas
Primary tumour (T)
pTa: non-invasive tumour.
pT1: tumour invades the lamina propria.
pT2: tumour invades the muscularis propria.
pT3: tumour invades perivesical tissue.
pT4: tumour invades adjacent organs (prostate, uterus, vagina, pelvic wall).
Regional lymph nodes (N)
pN1: single positive node in the primary drainage region.
pN2: multiple positive nodes in the primary drainage region.
pN3: common iliac node involvement.
TNM 7 pathological staging of renal pelvis and ureter
carcinomas
Primary tumour (T)
pTa: non-invasive tumour.
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