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Flat Urothelial Lesions

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Urinary Bladder Pathology

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Abstract

There are several clinical scenarios in which flat urothelial lesion needs to be evaluated by surgical pathologists. Pathological diagnosis of flat urothelial lesions should always correlate with the clinical history and gross findings. The general approach to the diagnosis of flat urothelial lesions can be categorized into three aspects: architecture arrangements, cytologic features, and background stroma. Based on the architecture and cytological changes, the flat urothelial lesions can be classified into urothelial hyperplasia, urothelial proliferation of unknown malignant potential (UPUMP), reactive atypia, urothelial atypia of unknown significance (UAUS), urothelial dysplasia, and urothelial carcinoma in situ (CIS). The principal histological features of CIS include loss of polarity, marked nuclear crowding, pleomorphism, and frequent mitoses. There are varied cytologic and architectural patterns in the histologic presentation of CIS. Neoplastic cells of CIS may also partially involve the normal urothelium by pagetoid spreading or undermining. Colonization of CIS into von Brunn nests has to be differentiated from true stromal invasion. Several immunohistochemical markers have been suggested diagnostic utility for CIS, among which CK20 and p53 are the most widely applied markers. Most of the CIS express luminal markers, but the luminal type of CIS can undergo a class switch to basal type during progression. The prognosis of CIS depends on the extent of disease, the involvement of prostatic urethra, and the response to therapy.

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Author information

Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, British Columbia Cancer Vancouver Centre, Vancouver, BC, Canada

    Gang Wang

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  1. Gang Wang
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Correspondence to Gang Wang .

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Editors and Affiliations

  1. Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA

    Haijun Zhou

  2. Department of Pathology, MD Anderson Cancer Center, Houston, TX, USA

    Charles C. Guo

  3. Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA

    Jae Y. Ro

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Wang, G. (2021). Flat Urothelial Lesions. In: Zhou, H., Guo, C.C., Ro, J.Y. (eds) Urinary Bladder Pathology. Springer, Cham. https://doi.org/10.1007/978-3-030-71509-0_3

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  • DOI: https://doi.org/10.1007/978-3-030-71509-0_3

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-030-71509-0

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