UROTHELIAL CARCINOMA

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N O R M A L H Y P E R P L A S I A D Y S P L A S I A C A I N S I T U
P A P I L O M A L M P L O W G R A D E H I G H G R A D E
Page 1 and 2: Basel Seminars in Pathology Postgra
Page 3 and 4: UPDATE ON PATHOLOGY STANDARDS FOR B
Page 5 and 6: Molecular Pathways for Bladder Canc
Page 7: HISTOLOGIC GRADE UROTHELIAL NEOPLAS
Page 10 and 11: What’s New in the 2012 Consensus
Page 12 and 13: Reporting of Bladder Cancer • Gui
Page 14 and 15: • Seen with instrumentation with
Page 16 and 17: Squamous Metaplasia • Should be r
Page 18 and 19: GRADING OF UROTHELIAL LESIONS • F
Page 20 and 21: NORMAL
Page 22 and 23: Urothelial Dysplasia • Overall fe
Page 24 and 25: Urothelial Dysplasia • The diagno
Page 28: ATYPIA OF UNKNOWN SIGNIFICANCE (WHO
Page 31 and 32: Grading of Urothelial Carcinoma •
Page 33 and 34: Papilloma
Page 35 and 36: PUNLMP
Page 37 and 38: LOW GRADE
Page 39: HIGHGRADE
Page 43 and 44: Courtesy R. Montironi, Italy Exophy
Page 45 and 46: Inverted High Grade without invasio
Page 47 and 48: Inverted Papilloma
Page 49 and 50: Inverted PUNLMP
Page 51 and 52: Inverted LG
Page 53 and 54: Inverted HG
Page 55 and 56: Inverted HG, Non Inv
Page 57 and 58: 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 and 110:
EMPHYSEMATOUS & BULLOUS CYSTITIS
Page 113 and 114:
AMYLOIDOSIS
Page 115 and 116:
MALAKOPLAKIA
Page 117:
NORMAL PARAGANGLIONIC TISSUE
Page 123 and 124:
CIS
Page 125:
REACTIVE ATYPIA History of stones,
Page 130:
CIS REACTIVE ATYPIA
Page 134 and 135:
RADIATION ATYPIA
Page 136:
INTRAVESICAL THERAPY
Page 141:
Polyoma Virus Infection • Usually
Page 149 and 150:
Papillary tumor Micropapillary U Ca
Page 151 and 152:
Low magnification distinction Broad
Page 153:
Cystoscopic & microscopic mimic Pap
Page 158 and 159:
Papillary Polypoid cystitis
Page 161 and 162:
ALL THAT IS PAPILLARY BLADDER IS NO
Page 165 and 166:
Bladder Biopsy Interpretation, 2nd
Page 167 and 168:
TIGHTLY CLUSTERED UROTHELIUM
Page 169 and 170:
TIGHTLY CLUSTERED UROTHELIUM
Page 171 and 172:
U Ca. with small tubules Nephrogeni
Page 173 and 174:
NEPHROGENIC ADENOMA - THE BIG MIMIC
Page 175:
NEPHROGENIC ADENOMA
Page 181:
NEPHROGENIC ADENOMA
Page 185 and 186:
NEPHROGENIC ADENOMA Clues to benign
Page 187 and 188:
FLORID REACTIVE PROLIFERATIONS norm
Page 195:
POST-RADIATION PSEUDOCARCINOMATOUS
Page 214:
LORID CYSTTTIS GLANDULARIS ITH MUCI
Page 222:
MULLERIANOSIS • Endometriosis, en
Page 233 and 234:
PSEUDOSARCOMATOUS MYOFIBROBLASTIC P
Page 235:
Gross PMP • Exophyticpolypoid mas
Page 246 and 247:
ROLE OF IMMUNOHISTOCHEMISTRY IN THE
Page 248 and 249:
PROVING UROTHELIAL DIFFERENTIATION
Page 250 and 251:
CA in the bladder, h.o of lung canc
Page 252 and 253:
Paraganglioma Epith. LMS PEComa Mel
Page 255 and 256:
p63
Page 257 and 258:
Plasmacytoid U Ca
Page 259 and 260:
• Markers of urothelium and uroth
Page 261 and 262:
S100P S100P GATA3 GATA3 A-F: S100P,
Page 263 and 264:
GATA 3 & S100 P: Diagnostic utility
Page 265 and 266:
PARAGANGLIOMA
Page 267:
Identification of Succinate Dehydro
Page 270 and 271:
CIS REACTIVE
Page 272 and 273:
NORMAL
Page 274 and 275:
CK-20
Page 276 and 277:
REACTIVE UROTHELIUM
Page 278 and 279:
CK-20
Page 280 and 281:
Reactive CD44
Page 282 and 283:
CA-INSITU
Page 284 and 285:
CK-20
Page 286 and 287:
CIS CK20
Page 288 and 289:
CK20 (+) CD44(-)
Page 290 and 291:
p53
Page 292 and 293:
CD44
Page 294 and 295:
Reactive CIS
Page 296 and 297:
Radiation-Reactive Radiation CIS
Page 298 and 299:
AUA GUIDELINE 2007 UPDATE: • Stan
Page 300 and 301:
Typical pattern: • Arranged in gr
Page 302 and 303:
Muscularis mucosae or muscularis pr
Page 304:
Am J Surg Pathol. 2009 ;33:91-8 SMO
Page 307 and 308:
Smoothelin hyperplastic
Page 309 and 310:
Smoothelin
Page 311 and 312:
SMA - M. Mucosae
Page 313 and 314:
Smoothelin
Page 315 and 316:
CAUTERY: MINIMAL EFFECT ON IHC
Page 318 and 319:
M. Mucosae vs. M. Propria in TURBT
Page 321 and 322:
M. Mucosae vs. M. Propria in TURBT
Page 323 and 324:
Smoothelin: Negative - Suggestive o
Page 325:
Courtesy: Dr John Eble
Page 329 and 330:
METASTASIS TO THE BLADDER Prostate
Page 331 and 332:
?Urothelial Carcinoma vs. ?Prostati
Page 333 and 334:
Concurrent PCa & UCa
Page 335 and 336:
PCa PCa NKX3.1 P501S PSMA
Page 338:
100% 100% 90% 88% 88% 88% 80% 70% 6
Page 342 and 343:
Clear cell Ca Neph. adenoma
Page 344 and 345:
U Ca. with small tubules Nephrogeni
Page 346 and 347:
Nephrogenic adenoma Clear cell aden
Page 348 and 349:
CCCa Pax 2 S100A1 Ki67
Page 350 and 351:
P Ca A Pax 2 S100A1 Ki67
Page 352 and 353:
PMP / Pseudotumors
Page 354 and 355:
SMA
Page 356:
Sarcomatoid urothelial carcinoma
Page 361:
Leiomyosarcoma
Page 365 and 366:
Spindle cell lesions Benign (PMP) v
Page 367:
SARC CA p63 CK 5/6 or HMCK p63
Page 370 and 371:
Session plan Renal Pathology for th
Page 372 and 373:
Tubules - Normal
Page 374 and 375:
Interstitial inflammation - tubuloi
Page 376 and 377:
Tubulointerstitial nephritis Classi
Page 378 and 379:
CKD, previous tuberculosis, HCV pos
Page 380 and 381:
AKI, ANCA positive, cortex - TIN, g
Page 382 and 383:
Male 59 years. Acute rise in creati
Page 384 and 385:
35 patients with IgG4-TIN: 27 (77%)
Page 386 and 387:
Male 70 years AKI Diagnosis?
Page 388 and 389:
Hantavirus nephropathy
Page 390 and 391:
Male, 57 years. Acute renal failure
Page 392 and 393:
Ascending infection (pyelonephritis
Page 394 and 395:
Tubulointerstitial infiltrates in t
Page 396 and 397:
Tubulointerstitial infiltrates in t
Page 398 and 399:
Things in tubules Casts, crystals,
Page 400 and 401:
Acute phosphate nephropathy First c
Page 402 and 403:
Diagnosis?
Page 404 and 405:
Acute tubular injury Ischaemia, dru
Page 406 and 407:
Light chain tubulopathy
Page 408 and 409:
Acute tubular injury in the post mo
Page 410 and 411:
Acute tubular injury in the post mo
Page 412 and 413:
Drug-associated tubular injury Drug
Page 414 and 415:
Gentamicin toxicity Diagnosis?
Page 416 and 417:
Drug-associated tubular injury Mech
Page 418 and 419:
Glomerular lesions Ian Roberts Oxfo
Page 420 and 421:
Tumour nephrectomy specimens Things
Page 422 and 423:
Glomeruli- Normal
Page 424 and 425:
Nodular glomerulosclerosis Diabetic
Page 426 and 427:
Diabetic nephropathy: thickened bas
Page 428 and 429:
Diabetic nephropathy: Diffuse mesan
Page 430 and 431:
Diabetic nephropathy: Insudative le
Page 432 and 433:
Amyloidosis Congo red
Page 434 and 435:
Amyloidosis
Page 436 and 437:
Amyloidosis
Page 438 and 439:
Immunotactoid Fibrillary GN 0.06% o
Page 440 and 441:
Light chain deposition disease
Page 442 and 443:
Focal segmental glomerulosclerosis
Page 444 and 445:
Page 446 and 447:
Page 448 and 449:
Glomerular lesions: proliferation M
Page 450 and 451:
Glomerular lesions: proliferation E
Page 452 and 453:
The diagnosis of IgA nephropathy is
Page 454 and 455:
The histology of IgA nephropathy is
Page 456 and 457:
Mesangiocapillary GN = Membranoprol
Page 458 and 459:
Mesangiocapillary GN, type I C3
Page 460 and 461:
C3 glomerulopathy MPGN and C3 glome
Page 462 and 463:
Dense deposit disease
Page 464 and 465:
Glomerular lesions: necrosis Ruptur
Page 466 and 467:
Renal vasculitis May be isolated re
Page 468 and 469:
Renal vasculitis European vasculiti
Page 470 and 471:
Anti-GBM disease Autoantibodies to
Page 472 and 473:
Remember: multiple pathologies are
Page 474 and 475:
Male 46 years. Suffered from diabet
Page 476 and 477:
Diagnoses: Diabetic nephropathy Oxa
Page 478 and 479:
Interactive Kidney Quiz Ian S. Robe
Page 480 and 481:
Test vote How did you learn about t
Page 482 and 483:
Set 1
Page 484 and 485:
PathoPic B
Page 486:
PathoPic D
Page 490 and 491:
What is your main diagnosis? 1. chr
Page 492 and 493:
What is your main diagnosis? 1. amy
Page 494 and 495:
What is your main diagnosis? 1. no
Page 496 and 497:
A PathoPic Dg: arteriolosclerosis,
Page 498 and 499:
Dg: diabetic kidney C PathoPic
Page 500 and 501:
Dg: malignant nephrosclerosis E
Page 502 and 503:
RCPath “Minimum” dataset for tu
Page 504 and 505:
Patterns of scarring Granular subca
Page 506 and 507:
Patterns of scarring Granular subca
Page 508 and 509:
Deep pitted cortical scars: Pattern
Page 510 and 511:
Patterns of scarring Deep pitted co
Page 512 and 513:
Patterns of scarring Segmental tran
Page 514 and 515:
Malignant hypertension A cause of a
Page 516 and 517:
Page 518 and 519:
Page 520 and 521:
Malignant vs benign vascular diseas
Page 522 and 523:
PathoPic G
Page 524:
PathoPic I
Page 528 and 529:
What is your main diagnosis? 1. gou
Page 530 and 531:
What is your main diagnosis? 1. met
Page 532 and 533:
What is your main diagnosis? 1. ren
Page 534 and 535:
Solutions (M.J. Mihatsch)
Page 536 and 537:
Descripition Involvement of cortex
Page 538 and 539:
Description Whitish discoloration a
Page 540 and 541:
Description Massive enlargement of
Page 542 and 543:
Description Brownish discoloration
Page 544 and 545:
Papillary necrosis Pg: i.e. vascula
Page 546 and 547:
Papillary necrosis Pg: i.e. vascula
Page 548 and 549:
Types of papillary necrosis: Extend
Page 550 and 551:
Black papillary necrosis Think of p
Page 552 and 553:
Phenacetin kidney Compete necrosis
Page 554 and 555:
Phenacetin kidney Note massive base
Page 556 and 557:
Phenacetin kidney Note: Massive lip
Page 558 and 559:
Typical examples of papillary necro
Page 560 and 561:
White papillary necrosis Think of v
Page 562 and 563:
Red papillary necrosis Think of vas
Page 564 and 565:
I hope you will never overlook papi
Page 566 and 567:
Challenges for Pathologists Renal M
Page 568:
Do the morphotypes of RCC have prog
Page 571 and 572:
Potential of Needle Biopsy • Diag
Page 573 and 574:
Novel renal tumor types with clear
Page 575 and 576:
Am J Surg Path 28, 2004 41 Carcinom
Page 578 and 579:
Should Acquired Cystic Disease- RCC
Page 580 and 581:
Clear cell papillary RCC has: 1. PO
Page 582 and 583:
Which name should be used for 1. Cl
Page 585 and 586:
1. Yes 2. No Should Thyroid-Like Fo
Page 587 and 588:
If focal (
Page 589 and 590:
Denote AMLs with epithelioid morpho
Page 591:
Differential Diagnosis of Cystic Re
Page 594 and 595:
smaller cysts with phyllodes glands
Page 596 and 597:
Are Cystic Nephroma and Mixed Epith
Page 598 and 599:
If you consider CN and MEST variati
Page 600 and 601:
Should Tubulocystic-RCC be recogniz
Page 602 and 603:
Prognosis • Type • Stage • Gr
Page 604:
Papillary renal cell carcinoma Type
Page 608 and 609:
Differential Diagnosis: metanephric
Page 610 and 611:
The distinction between type 1 vers
Page 612 and 613:
Should Oncocytic Papillary-RCC be r
Page 614:
Leiomyomas of the Skin
Page 618 and 619:
Fuhrman Grading in RCC Hong SK, BJU
Page 620 and 621:
How should we grade clear cell RCC?
Page 622:
How should we grade chromophobe RCC
Page 625 and 626:
For Sarcomatoid Tumors Do You Repor
Page 627 and 628:
Do You Consider a Tumor Area Sarcom
Page 629 and 630:
Tumor Staging
Page 631 and 632:
When invasion of the renal sinus is
Page 633 and 634:
Should the presence or absence of t
Page 635 and 636:
Should any assessment of amount (pe
Page 637 and 638:
ISUP Consensus Conference Vancouver
Page 639 and 640:
Molecular Pathways and Targeted The
Page 641:
Chemokine receptor CXCR4 downregula
Page 644 and 645:
Agents such as sunitinib act throug
Page 646 and 647:
VHL-Mutation ↔ Gene expression Ba
Page 648 and 649:
Driver and Passenger VHL Mutations
Page 650:
Differential Diagnosis of Renal Cel
Page 653:
Renal Tumors with Eosinophilic Cyto
Page 658:
Birt Hogg Dubé syndrome
Page 661 and 662:
Are the hybrid tumors associated wi
Page 663 and 664:
For distinguishing clear cell RCC f
Page 665 and 666:
Clear Cell Renal Cancer VHL Deletio
Page 667 and 668:
Early on in VHL disease, the vast m
Page 669 and 670:
Distinct tumor suppressor mechanism
Page 671 and 672:
A Ksp-Cre - pos - pos - pos Vhlh fl
Page 673 and 674:
pVHL localizes to primary cilia in
Page 675 and 676:
a c b d Montani et al.: Am J Surg P
Page 677 and 678:
Multilocular cystic renal cell carc
Page 679 and 680:
What terminology for a multicystic
Page 681 and 682:
In the setting of acquired cystic d
Page 683 and 684:
„Translocation“ Type of Renal C
Page 685 and 686:
„Translocation“ Type of Renal C
Page 687:
t(X;1)
Page 690 and 691:
Should t(6;11) RCC be Recognized as
Page 693 and 694:
When a translocation carcinoma is s
Page 696:
Leiomyomatous Renal Cell Carcinoma
Page 699:
Edmunds W: Trans.Path.Soc.London 43
Page 702 and 703:
Are Cystic Nephroma and Mixed Epith
Page 704 and 705:
Renal Tumors with Papillary Archite
Page 706 and 707:
In the absence of classical histolo
Page 708 and 709:
Clin Cancer Res 2009;15:3297-3304 -
Page 710 and 711:
A, Western blot analysis of HK-2 ce
Page 712:
Tumors with Spindle Cell Morphology
Page 716 and 717:
Which marker do you use most freque
Page 719 and 720:
Primary Renal Synovial Sarcoma Immu
Page 721:
SYT-SSX Fusion from translocation t
Page 726:
Renal carcinoid from a horseshoe ki
Page 729:
DD „Small round blue“ cell tumo
Page 733 and 734:
Xu X. et al.L Cell 148, 886-895, 20
Page 736 and 737:
Polybromo-1 (BAF180) in ccRCC ~40%
Page 738 and 739:
wt versus VHL-/- cells VHL-loss der
Page 740 and 741:
VHL and a Serum Screening Test for
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