UROTHELIAL CARCINOMA

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What percent of a tumor needs to be classic collecting duct carcinoma when associated with undifferentiated carcinoma in order to diagnose as collecting duct carcinoma as opposed to unclassified carcinoma? 1. >10% 2. >50% 3. >90% 4. 100% 5. Not sure or insufficient experience with entity 77% 5% 3% 6% 10% 1 2 3 4 5
Denote AMLs with epithelioid morphology as “epithelioid AMLs” which are then divided into epithelioid AMLs without and with atypia, the latter category associated in the literature with malignant potential. 1. Yes 2. No 3. Uncertain even with personal experience/ knowledge 4. Not enough personal experience/knowledge 86% 8% 2% 4% 1 2 3 4
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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
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Contributions of WHO (2004) /ISUP
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Handling grade heterogeneity in bla
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Grading Papillary Urothelial Neopla
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Papillary Hyperplasia with Cytologi
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Dysplasia with early papillary feat
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Grading Invasive Cancer • Practic
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• 2 types of muscle - awareness i
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Muscularis Mucosae Muscle • Hyper
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M. mucosae muscle patterns Typical
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M. mucosae muscle pattern Hypertrop
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Muscularis Propria • Several term
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Muscle Involved by UCa, Indetermina
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Assessment of pT2 vs. pT3 - cystect
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Microinvasive Urothelial Carcinoma
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Substratification or Substaging of
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Extensive invasion
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Retraction a mimic of vascular-lymp
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Vascular Lymphatic Invasion (LVI)
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2013 International Society of Urolo
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Lymph node involvement: • Approx.
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THE BEST BLADDER CANCER PATHOLOGY S
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PSEUDONEOPLASTIC MIMICS OF BLADDER
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EMPHYSEMATOUS & BULLOUS CYSTITIS
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AMYLOIDOSIS
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MALAKOPLAKIA
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NORMAL PARAGANGLIONIC TISSUE
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CIS
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REACTIVE ATYPIA History of stones,
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CIS REACTIVE ATYPIA
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RADIATION ATYPIA
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INTRAVESICAL THERAPY
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Polyoma Virus Infection • Usually
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Papillary tumor Micropapillary U Ca
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Low magnification distinction Broad
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Cystoscopic & microscopic mimic Pap
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Papillary Polypoid cystitis
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ALL THAT IS PAPILLARY BLADDER IS NO
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Bladder Biopsy Interpretation, 2nd
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TIGHTLY CLUSTERED UROTHELIUM
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TIGHTLY CLUSTERED UROTHELIUM
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U Ca. with small tubules Nephrogeni
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NEPHROGENIC ADENOMA - THE BIG MIMIC
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NEPHROGENIC ADENOMA
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NEPHROGENIC ADENOMA
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NEPHROGENIC ADENOMA Clues to benign
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FLORID REACTIVE PROLIFERATIONS norm
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POST-RADIATION PSEUDOCARCINOMATOUS
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LORID CYSTTTIS GLANDULARIS ITH MUCI
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MULLERIANOSIS • Endometriosis, en
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PSEUDOSARCOMATOUS MYOFIBROBLASTIC P
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Gross PMP • Exophyticpolypoid mas
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ROLE OF IMMUNOHISTOCHEMISTRY IN THE
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PROVING UROTHELIAL DIFFERENTIATION
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CA in the bladder, h.o of lung canc
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Paraganglioma Epith. LMS PEComa Mel
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p63
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Plasmacytoid U Ca
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• Markers of urothelium and uroth
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S100P S100P GATA3 GATA3 A-F: S100P,
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GATA 3 & S100 P: Diagnostic utility
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PARAGANGLIOMA
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Identification of Succinate Dehydro
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CIS REACTIVE
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NORMAL
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CK-20
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REACTIVE UROTHELIUM
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CK-20
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Reactive CD44
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CA-INSITU
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CK-20
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CIS CK20
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CK20 (+) CD44(-)
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p53
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CD44
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Reactive CIS
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Radiation-Reactive Radiation CIS
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AUA GUIDELINE 2007 UPDATE: • Stan
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Typical pattern: • Arranged in gr
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Muscularis mucosae or muscularis pr
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Am J Surg Pathol. 2009 ;33:91-8 SMO
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Smoothelin hyperplastic
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Smoothelin
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SMA - M. Mucosae
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Smoothelin
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CAUTERY: MINIMAL EFFECT ON IHC
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M. Mucosae vs. M. Propria in TURBT
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M. Mucosae vs. M. Propria in TURBT
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Smoothelin: Negative - Suggestive o
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Courtesy: Dr John Eble
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METASTASIS TO THE BLADDER Prostate
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?Urothelial Carcinoma vs. ?Prostati
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Concurrent PCa & UCa
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PCa PCa NKX3.1 P501S PSMA
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100% 100% 90% 88% 88% 88% 80% 70% 6
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Clear cell Ca Neph. adenoma
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U Ca. with small tubules Nephrogeni
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Nephrogenic adenoma Clear cell aden
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CCCa Pax 2 S100A1 Ki67
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P Ca A Pax 2 S100A1 Ki67
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PMP / Pseudotumors
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SMA
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Sarcomatoid urothelial carcinoma
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Leiomyosarcoma
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Spindle cell lesions Benign (PMP) v
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SARC CA p63 CK 5/6 or HMCK p63
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Session plan Renal Pathology for th
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Tubules - Normal
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Interstitial inflammation - tubuloi
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Tubulointerstitial nephritis Classi
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CKD, previous tuberculosis, HCV pos
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AKI, ANCA positive, cortex - TIN, g
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Male 59 years. Acute rise in creati
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35 patients with IgG4-TIN: 27 (77%)
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Male 70 years AKI Diagnosis?
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Hantavirus nephropathy
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Male, 57 years. Acute renal failure
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Ascending infection (pyelonephritis
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Tubulointerstitial infiltrates in t
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Tubulointerstitial infiltrates in t
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Things in tubules Casts, crystals,
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Acute phosphate nephropathy First c
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Diagnosis?
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Acute tubular injury Ischaemia, dru
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Light chain tubulopathy
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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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Drug-associated tubular injury Drug
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Gentamicin toxicity Diagnosis?
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Drug-associated tubular injury Mech
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Glomerular lesions Ian Roberts Oxfo
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Tumour nephrectomy specimens Things
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Glomeruli- Normal
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Nodular glomerulosclerosis Diabetic
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Diabetic nephropathy: thickened bas
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Diabetic nephropathy: Diffuse mesan
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Diabetic nephropathy: Insudative le
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Amyloidosis Congo red
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Amyloidosis
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Amyloidosis
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Immunotactoid Fibrillary GN 0.06% o
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Light chain deposition disease
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Focal segmental glomerulosclerosis
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Glomerular lesions: proliferation M
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Glomerular lesions: proliferation E
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The diagnosis of IgA nephropathy is
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The histology of IgA nephropathy is
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Mesangiocapillary GN = Membranoprol
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Mesangiocapillary GN, type I C3
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C3 glomerulopathy MPGN and C3 glome
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Dense deposit disease
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Glomerular lesions: necrosis Ruptur
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Renal vasculitis May be isolated re
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Renal vasculitis European vasculiti
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Anti-GBM disease Autoantibodies to
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Remember: multiple pathologies are
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Male 46 years. Suffered from diabet
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Diagnoses: Diabetic nephropathy Oxa
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Interactive Kidney Quiz Ian S. Robe
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Test vote How did you learn about t
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Set 1
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PathoPic B
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PathoPic D
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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,
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Dg: diabetic kidney C PathoPic
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Dg: malignant nephrosclerosis E
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RCPath “Minimum” dataset for tu
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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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Malignant vs benign vascular diseas
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PathoPic G
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PathoPic I
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What is your main diagnosis? 1. gou
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What is your main diagnosis? 1. met
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What is your main diagnosis? 1. ren
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Solutions (M.J. Mihatsch)
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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: If focal (
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
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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
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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
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Early on in VHL disease, the vast m
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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
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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
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Leiomyomatous Renal Cell Carcinoma
Page 699:
Edmunds W: Trans.Path.Soc.London 43
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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
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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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UROTHELIAL CARCINOMA

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