UROTHELIAL CARCINOMA

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EMPHYSEMATOUS & BULLOUS CYSTITIS
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Basel Seminars in Pathology Postgra
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UPDATE ON PATHOLOGY STANDARDS FOR B
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Molecular Pathways for Bladder Canc
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HISTOLOGIC GRADE UROTHELIAL NEOPLAS
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What’s New in the 2012 Consensus
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Reporting of Bladder Cancer • Gui
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• Seen with instrumentation with
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Squamous Metaplasia • Should be r
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GRADING OF UROTHELIAL LESIONS • F
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NORMAL
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Urothelial Dysplasia • Overall fe
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Urothelial Dysplasia • The diagno
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ATYPIA OF UNKNOWN SIGNIFICANCE (WHO
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Grading of Urothelial Carcinoma •
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Papilloma
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PUNLMP
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LOW GRADE
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HIGHGRADE
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P A P I L O M A L M P L O W G R A D
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Courtesy R. Montironi, Italy Exophy
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Inverted High Grade without invasio
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Inverted Papilloma
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Inverted PUNLMP
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Inverted LG
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Inverted HG
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Inverted HG, Non Inv
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WHO (2004) /ISUP : Prognostic Signi
Page 59 and 60: Contributions of WHO (2004) /ISUP
Page 61 and 62: Handling grade heterogeneity in bla
Page 63 and 64: Grading Papillary Urothelial Neopla
Page 65: Papillary Hyperplasia with Cytologi
Page 68 and 69: Dysplasia with early papillary feat
Page 70 and 71: Grading Invasive Cancer • Practic
Page 74 and 75: • 2 types of muscle - awareness i
Page 76 and 77: Muscularis Mucosae Muscle • Hyper
Page 78 and 79: M. mucosae muscle patterns Typical
Page 80 and 81: M. mucosae muscle pattern Hypertrop
Page 82 and 83: Muscularis Propria • Several term
Page 84 and 85: Muscle Involved by UCa, Indetermina
Page 88 and 89: Assessment of pT2 vs. pT3 - cystect
Page 91 and 92: Microinvasive Urothelial Carcinoma
Page 93 and 94: Substratification or Substaging of
Page 95 and 96: Extensive invasion
Page 97 and 98: Retraction a mimic of vascular-lymp
Page 99 and 100: Vascular Lymphatic Invasion (LVI)
Page 101 and 102: 2013 International Society of Urolo
Page 103 and 104: Lymph node involvement: • Approx.
Page 105 and 106: THE BEST BLADDER CANCER PATHOLOGY S
Page 107 and 108: PSEUDONEOPLASTIC MIMICS OF BLADDER
Page 109: EMPHYSEMATOUS & BULLOUS CYSTITIS
Page 114 and 115: AMYLOIDOSIS
Page 116 and 117: MALAKOPLAKIA
Page 119: CK AE1/AE3 SYNATOPHYSIN
Page 124 and 125: CIS
Page 129 and 130: FLAT LESIONS WITH ATYPIA PROBLEMS A
Page 132: FLAT LESIONS WITH ATYPIA PROBLEMS A
Page 135 and 136: RADIATION ATYPIA
Page 138: Polyoma virus Isolated or clusters
Page 144: ALL THAT IS PAPILLARY BLADDER IS NO
Page 150 and 151: BEFORE YOU ASSIGN A WHO (2004)/ISUP
Page 152 and 153: Broad-based stalk or core • Polyp
Page 155: Papillary Polypoid cystitis
Page 159: FIBROEPITHELIAL POLYP
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Avulsion
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Epstein, Reuter, Amin Bladder Biops
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TIGHTLY CLUSTERED UROTHELIUM
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APPROACH • Be very hesitant to ma
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NEPHROGENIC ADENOMA Pitfalls: • P
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NEPHROGENIC ADENOMA
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NEPHROGENIC ADENOMA
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Fibromyxoid variant
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FLORID REACTIVE PROLIFERATIONS •
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Nested Variant Von Brunn’s nests
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Microcystic variant Cystitis cystic
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FLORID CYSTITIS GLANDULARIS WITH MU
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Pseudosarcomatous stromal reaction
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PSEUDOSARCOMATOUS MYOFIBROBLASTIC P
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PSEUDOSARCOMATOUS MYOFIBROBLASTIC P
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IHC IN BLADDER PATHOLOGY • Provin
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CA in a cervical LN.
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UROTHELIAL CARCINOMA (Prim. or Meta
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URINARY BLADDER - IHC •Diagnosis
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Uroplakin 3
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Plasmacytoid U.Ca - CK20
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S100P(commercial) • Nuclear stain
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• Nuclear staining • lower sens
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UROTHELIAL CA
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PARAGANGLIOMA OF THE BLADDER - DIFF
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CIS REACTIVE ATYPIA
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IMMUNOHISTOCHEMISTRY IN FLAT LESION
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NORMAL p53
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CD-44
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p53
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CD-44
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Reactive- CK20 Reactive- p53 Fig 9C
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p53
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CD44
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p53 Regenerative basal cells vs. cl
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PAGETOID CIS
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CK20
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p53 CK20 CD44
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Post BCG Reactive Post BCG CIS
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• 2 types of muscle - awareness i
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Typical Hypertrophic-Haphazard Hype
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Muscularis mucosae or muscularis pr
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IMMUNOHISTOCHEMICAL MARKERS IN BLAD
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SMA hyperplastic
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SMA
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Hypertrophic muscularis mucosae
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Smoothelin - M. Mucosae
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SMOOTHELIN IN DESMOPLASIA: NEGATIVE
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TYPES OF MUSCULARIS PROPRIA INVASIO
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Smoothelin SPLAYING/FRACTURING OF M
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SMA
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METASTATIC ADENOCARCINOMA TO THE BL
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CK 7 CK20 CDX2 B-CATENIN
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New Prostate Lineage Associated Mar
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?Urothelial Carcinoma vs. ?Prostati
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UCa GATA3 CK5/6 S100P
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Prostatic adenocarcinoma ERG IHC Ur
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AMACR
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Clear cell Ca Neph. adenoma
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U Ca. with small tubules Nephrogeni
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NA Pax 2 S100A1 Ki67
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U Ca Pax 2 S100A1 Ki67
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Spindle cell lesions of bladder •
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PSFMT/ PMP Immunohistochemistry •
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Keratin-AE1/AE3 Desmin
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AE1/AE3
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SMA
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PMP ALK 1 KERATIN AE1/3 SMA
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Tubulointerstitial lesions Ian Robe
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Tubules - Normal
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Tubules - Atrophy Distribution give
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Interstitial inflammation - tubuloi
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Tubulointerstitial nephritis The na
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AKI, ANCA positive, cortex - TIN, g
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Beware TIN + red cell casts In rena
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Male 59 years. Acute rise in creati
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IgG4-related TIN
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Male 70 years AKI Rigors, breathles
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Male, 57 years. Acute renal failure
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Ascending infection (pyelonephritis
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Ascending infection (pyelonephritis
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PVN can be seen in native kidneys L
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Tubulointerstitial infiltrates in t
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Female, 57 years. Acute renal failu
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Haemoglobin Myoglobin Diagnosis?
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Diagnosis?
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Light chain tubulopathy Typically a
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Light chain tubulopathy kappa lambd
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Acute tubular injury in the post mo
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Acute tubular injury in the post mo
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Tacrolimus toxicity Diagnosis?
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Drug-associated tubular injury Mech
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The End
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Session plan Renal Pathology for th
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Tumour nephrectomy specimens Common
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Glomerular lesions - sclerosis Scle
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Diabetic nephropathy Earliest chang
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Diabetic nephropathy: Linear GBM po
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Diabetic nephropathy: Nodular scler
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Amyloidosis
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Amyloidosis
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Amyloidosis Beware! Congo red may b
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Immunotactoid Fibrillary GN
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Light chain deposition disease
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Light chain deposition disease
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Idiopathic FSGS Known cause of podo
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Focal segmental glomerulosclerosis
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Glomerular tip lesion A manifestati
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Glomerular lesions: proliferation M
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IgA nephropathy Commonest glomerulo
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Mesangial deposits have a character
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Classification of IgA nephropathy O
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MPGN, type I • Haematuria, protei
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C3 glomerulopathy = Isolated C3 dep
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Haematuria (90%), nephrotic syndrom
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Dense deposit disease
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Crescentic glomerulonephritis patte
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Arteritis (approx. 20%) Renal vascu
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Anti-GBM disease • Autoantibodies
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Anti-GBM disease Linear IgG in glom
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Male 46 years. Suffered from diabet
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Male 46 years. Suffered from diabet
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The End
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What to do? • Download Kidney Qui
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What to do? • Participants will s
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PathoPic A
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PathoPic C
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What is your main diagnosis? 1. chr
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What is your main diagnosis? 1. art
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What is your main diagnosis? 1. mal
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Solutions (I.S. Roberts)
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B PathoPic Dg: crescentic glomerulo
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D PathoPic Dg: no significant patho
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Dg: amyloidosis F
Page 503 and 504:
Patterns of scarring Granular subca
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Patterns of scarring Granular subca
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Deep pitted cortical scars: Pattern
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Patterns of scarring Deep pitted co
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Patterns of scarring Segmental tran
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Malignant hypertension A cause of a
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Page 517 and 518:
Page 519 and 520:
Page 521 and 522:
Set 2
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PathoPic H
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PathoPic L
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What is your main diagnosis? 1. col
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What is your main diagnosis? 1. nec
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What is your main diagnosis? 1. Ran
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Descripition Involvement of cortex
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Description enlargement of the kidn
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Differential diagnosis Acute uric a
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Differences between megalocytic IN
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Comments to papillary necrosis
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Prevalence of Lesions of the Renal
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Pathogenetic types of papillary nec
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Types of papillary necrosis: Extend
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Phenacetin kidney Keep in mind: bla
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Phenacetin kidney Note bone formati
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Phenacetin kidney Capillary scleros
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Yellow papillary necrosis Think of
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Histological examples of papillary
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Typical examples of papillary necro
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Typical examples of papillary necro
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Common Challenges in Kidney Cancer
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ISUP Consensus Conference Vancouver
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Image-guided biopsy. Shah et al.: H
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Can we confidently diagnose renal o
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„Translocation“ Type of Renal C
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Xp11 Translocation Carcinoma in Adu
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Clear cell-papillary RCC, sporadic
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Should CCPRCC/CCTPRCC be Recognized
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Do you think CCPRCC/CCTPRCC and RAT
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DIFFERENTIAL DIAGNOSIS OF EOSINOPHI
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What percent of a tumor needs to be
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Assess prognosis in epithelioid AML
Page 593 and 594:
Mixed Epithelial and Stromal Tumor
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Are Cystic Nephroma and Mixed Epith
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Do you consider CN and MEST variati
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Tubulocystic RCC
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Challenges for Pathologists Diagnos
Page 603 and 604:
Sporadic Renal Cell Carcinoma Moch
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Definition Adenoma • Tumours with
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Survival (%) Type and Prognosis of
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How do you subtype papillary renal
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Hereditary Leiomyomatosis and RCC S
Page 617 and 618:
Should HLRCC be Recognized as a Dis
Page 619 and 620:
Grading of Chromophobe RCC Amin MA,
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How should we grade papillary RCC?
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Unlike the Skywalker family, once t
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Survival (%) Prognostic Relevance o
Page 628 and 629:
If a Tumor Shows Sarcomatoid Morpho
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Tumor Staging Bonsib SM. Renal lymp
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For staging purposes, do you consid
Page 634 and 635:
Should the component of necrosis be
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Challenges for Pathologists Diagnos
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A proposed marker-based strategy de
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VHL and tumor development Frew and
Page 643 and 644:
Randomised studies in the first lin
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J Urology 180, pp. 860-866, 2008
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Frequenz VHL Mutation in clear cell
Page 649 and 650:
Thank you
Page 652 and 653:
Potential of Needle Biopsy • Diag
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Hereditary Renal Cancer Syndromes
Page 660 and 661:
How should HOCT be recognized? 1. S
Page 662 and 663:
Novel renal tumor types with clear
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Renal Tumors with Clear Cytoplasm A
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CA IX and Tumor Development Mutatio
Page 668 and 669:
Montani et al.: Am J Surg Path, May
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Is loss of VHL sufficient to cause
Page 672 and 673:
Inside the primary cilium Receptors
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a b c d e f Montani et al.: Am J Su
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Additional mutation in VHL-/- cells
Page 678 and 679:
Is it Acceptable for MC-RCC to have
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Renal Cyst in ADPKD Ki-67
Page 682 and 683:
Novel renal tumor types with clear
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TFE3-Proteine-Expression
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• 14/28 pts: Stage 4 • 11/13 pt
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Translocation Carcinomas (MiTF/TFE
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When should TFE3 and TFEB analysis
Page 694:
Clear cell-papillary RCC, sporadic
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Differential Diagnosis of Cystic Re
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Are Cystic Nephroma and Mixed Epith
Page 703 and 704:
smaller cysts with phyllodes glands
Page 705 and 706:
Immunohistochemistry MTSC (%) Papil
Page 707 and 708:
Which IHC marker do you think is th
Page 709 and 710:
PAX2 expression pattern in 16 spora
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PAX2 expression and overall surviva
Page 715 and 716:
Tumors with Spindle Cell Morphology
Page 717:
Small Blue Round Cell Tumors of Kid
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CD-99
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CD 99 Ewing-Sarcoma/PNET
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Synaptophysin
Page 731:
The future has arrived 82
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VHL and Deep Sequencing • several
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Loss of PBRM1 expression is correla
Page 739 and 740:
Cell Surface Capturing Proteomics:
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Conclusions •Renal mass biopsy -
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