Definition/General
Introduction:
Urothelial carcinoma is the most common malignancy of the urinary bladder
It accounts for 90% of all bladder cancers
Previously called transitional cell carcinoma
Non-muscle invasive (75%) and muscle invasive (25%) types.
Origin:
Arises from urothelial lining of bladder, ureter, or renal pelvis
Multifocal disease common
Results from field cancerization
Papillary or flat growth patterns
CIS as precursor lesion.
Classification:
WHO/ISUP classification: Low-grade and High-grade
Non-invasive (pTa, pTis) and Invasive (pT1-T4)
Papillary and Non-papillary variants
Pure and mixed histologies.
Epidemiology:
Peak incidence 60-70 years
Male predominance (3-4:1)
Smoking (major risk factor)
Occupational exposure (aromatic amines)
Schistosomiasis (endemic areas).
Clinical Features
Presentation:
Gross hematuria (85% cases)
Microscopic hematuria
Dysuria
Urinary frequency
Urgency
Suprapubic pain
Pelvic mass (advanced cases).
Symptoms:
Painless hematuria (classic)
Irritative voiding symptoms
Pelvic pain
Flank pain (ureteral involvement)
Weight loss
Bone pain (metastases).
Risk Factors:
Tobacco smoking (4-fold increase)
Occupational chemicals (benzidine, naphthylamine)
Cyclophosphamide
Radiation therapy
Chronic inflammation
Schistosoma haematobium.
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Gross Description
Microscopic Description
Immunohistochemistry
Molecular/Genetic
Differential Diagnosis
Sample Pathology Report
Template Format
Sample Pathology Report
Complete Report: This is an example of how the final pathology report should be structured for this condition.
Specimen Information
[TURBT/Cystectomy], [location], [procedure details]
Tumor Size
Tumor measures [X] x [Y] cm, [papillary/solid/ulcerated]
Histologic Type
Urothelial carcinoma, [conventional/variant] type
Grade
[Low-grade/High-grade] (WHO/ISUP 2016)
Depth of Invasion
Invades [lamina propria/muscularis propria/perivesical fat]
Muscularis Propria
Muscularis propria: [present/absent] in specimen
Pathologic Stage
pT[stage] (AJCC 8th edition)
Lymphovascular Invasion
Lymphovascular invasion: [present/absent]
Margins
Surgical margins: [negative/positive/cannot be assessed]
Carcinoma in situ
Carcinoma in situ: [present/absent]
Histologic Variants
Variant histology: [present/absent], type: [specify]
Final Diagnosis
Final diagnosis: Urothelial carcinoma, [grade], pT[stage]