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Papillary and Inverted Tumors

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Urinary Bladder Pathology

Abstract

Papillary neoplasms are a group of characteristic lesions of the urinary bladder, ranging from benign growths to malignant tumors. Papillary and inverted growth features can be identified grossly and microscopically. The classification of papillary neoplasms based on the new World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading system is widely applied, although interobserver agreement varies, particularly with low-grade lesions. Differentiating high-grade urothelial carcinoma with inverted growth patterns from noninvasive inverted tumors is important, and neoplastic papillary lesions should be differentiated from reactive papillary changes. Papillary neoplasms are often treated by transurethral resection either with or without intravesical therapy, and accurate pathological assessment of these lesions plays a key role in the clinical management of patients.

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References

  1. Epstein JI, Amin MB, Reuter VR, Mostofi FK. The World Health Organization/International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee. Am J Surg Pathol. 1998;22(12):1435–48.

    Google Scholar 

  2. Montironi R, Mazzucchelli R, Scarpelli M, Lopez-Beltran A, Cheng L. Morphological diagnosis of urothelial neoplasms. J Clin Pathol. 2008;61(1):3–10.

    Google Scholar 

  3. Moch H. HPA, Ulbright T.M., Reuter V.E. WHO Classification of Tumours of the Urinary Stem and Male Genital Organs. Lyon, France: International Agency for Research on Cancer (IARC) 2016.

    Google Scholar 

  4. Cheng L, Darson M, Cheville JC, Neumann RM, Zincke H, Nehra A, et al. Urothelial papilloma of the bladder. Clinical and biologic implications. Cancer. 1999;86(10):2098–101.

    Google Scholar 

  5. McKenney JK, Amin MB, Young RH. Urothelial (transitional cell) papilloma of the urinary bladder: a clinicopathologic study of 26 cases. Mod Pathol. 2003;16(7):623–9.

    Google Scholar 

  6. Magi-Galluzzi C, Epstein JI. Urothelial papilloma of the bladder: a review of 34 de novo cases. Am J Surg Pathol. 2004;28(12):1615–20.

    Google Scholar 

  7. van Rhijn BW, Montironi R, Zwarthoff EC, Jöbsis AC, van der Kwast TH. Frequent FGFR3 mutations in urothelial papilloma. J Pathol. 2002;198(2):245–51.

    Google Scholar 

  8. Cheng L, Montironi R, Lopez-Beltran A. TERT Promoter Mutations Occur Frequently in Urothelial Papilloma and Papillary Urothelial Neoplasm of Low Malignant Potential. Eur Urol. 2017;71(3):497–8.

    Google Scholar 

  9. Harnden P, Mahmood N, Southgate J. Expression of cytokeratin 20 redefines urothelial papillomas of the bladder. Lancet. 1999;353(9157):974–7.

    Google Scholar 

  10. Al Bashir S, Yilmaz A, Gotto G, Trpkov K. Long term outcome of primary urothelial papilloma: a single institution cohort. Pathology. 2014;46(1):37–40.

    Google Scholar 

  11. Sung MT, Maclennan GT, Lopez-Beltran A, Montironi R, Cheng L. Natural history of urothelial inverted papilloma. Cancer. 2006;107(11):2622–7.

    Google Scholar 

  12. Hodges KB, Lopez-Beltran A, Maclennan GT, Montironi R, Cheng L. Urothelial lesions with inverted growth patterns: histogenesis, molecular genetic findings, differential diagnosis and clinical management. BJU Int. 2011;107(4):532–7.

    Google Scholar 

  13. Williamson SR, Zhang S, Lopez-Beltran A, Montironi R, Wang M, Cheng L. Telomere shortening distinguishes inverted urothelial neoplasms. Histopathology. 2013;62(4):595–601.

    Google Scholar 

  14. Montironi R, Cheng L, Lopez-Beltran A, Scarpelli M, Mazzucchelli R, Mikuz G, et al. Inverted (endophytic) noninvasive lesions and neoplasms of the urothelium: the Cinderella group has yet to be fully exploited. Eur Urol. 2011;59(2):225–30.

    Google Scholar 

  15. Lott S, Wang M, Zhang S, MacLennan GT, Lopez-Beltran A, Montironi R, et al. FGFR3 and TP53 mutation analysis in inverted urothelial papilloma: incidence and etiological considerations. Mod Pathol. 2009;22(5):627–32.

    Google Scholar 

  16. Cheng CW, Chan LW, Chan CK, Ng CF, Cheung HY, Chan SY, et al. Is surveillance necessary for inverted papilloma in the urinary bladder and urethra? ANZ J Surg. 2005;75(4):213–7.

    Google Scholar 

  17. Cheng L, Leibovich BC, Cheville JC, Ramnani DM, Sebo TJ, Nehra A, et al. Squamous papilloma of the urinary tract is unrelated to condyloma acuminata. Cancer. 2000;88(7):1679–86.

    Google Scholar 

  18. Guo CC, Fine SW, Epstein JI. Noninvasive squamous lesions in the urinary bladder: a clinicopathologic analysis of 29 cases. Am J Surg Pathol. 2006;30(7):883–91.

    Google Scholar 

  19. Taylor DC, Bhagavan BS, Larsen MP, Cox JA, Epstein JI. Papillary urothelial hyperplasia. A precursor to papillary neoplasms. Am J Surg Pathol. 1996;20(12):1481–8.

    Google Scholar 

  20. Cheng L, Bostwick DG. Overdiagnosis of bladder carcinoma. Anal Quant Cytol Histol. 2008;30(5):261–4.

    Google Scholar 

  21. Cheng L, MacLennan GT, Zhang S, Wang M, Pan CX, Koch MO. Laser capture microdissection analysis reveals frequent allelic losses in papillary urothelial neoplasm of low malignant potential of the urinary bladder. Cancer. 2004;101(1):183–8.

    Google Scholar 

  22. MacLennan GT, Kirkali Z, Cheng L. Histologic grading of noninvasive papillary urothelial neoplasms. Eur Urol. 2007;51(4):889-97; discussion 897–8.

    Google Scholar 

  23. Jones TD, Cheng L. Papillary urothelial neoplasm of low malignant potential: evolving terminology and concepts. J Urol. 2006;175(6):1995–2003.

    Google Scholar 

  24. Montironi R, Lopez-Beltran A, Mazzucchelli R, Bostwick DG. Classification and grading of the non-invasive urothelial neoplasms: recent advances and controversies. J Clin Pathol. 2003;56(2):91–5.

    Google Scholar 

  25. Lopez-Beltran A, Montironi R. Non-invasive urothelial neoplasms: according to the most recent WHO classification. Eur Urol. 2004;46(2):170–6.

    Google Scholar 

  26. Alsheikh A, Mohamedali Z, Jones E, Masterson J, Gilks CB. Comparison of the WHO/ISUP classification and cytokeratin 20 expression in predicting the behavior of low-grade papillary urothelial tumors. World/Health Organization/Internattional Society of Urologic Pathology. Mod Pathol. 2001;14(4):267–72.

    Google Scholar 

  27. Montironi R, Lopez-Beltran A, Scarpelli M, Mazzucchelli R, Cheng L. Morphological classification and definition of benign, preneoplastic and non-invasive neoplastic lesions of the urinary bladder. Histopathology. 2008;53(6):621–33.

    Google Scholar 

  28. Montironi R, Cheng L, Scarpelli M, Mazzucchelli R, Lopez-Beltran A. How much do you know about benign, preneoplastic, non-invasive and invasive neoplastic lesions of the urinary bladder classified according to the 2004 WHO scheme? Diagn Pathol. 2011;6:31.

    Google Scholar 

  29. Pan CC, Chang YH, Chen KK, Yu HJ, Sun CH, Ho DM. Prognostic significance of the 2004 WHO/ISUP classification for prediction of recurrence, progression, and cancer-specific mortality of non-muscle-invasive urothelial tumors of the urinary bladder: a clinicopathologic study of 1,515 cases. Am J Clin Pathol. 2010;133(5):788–95.

    Google Scholar 

  30. Cheng L, Neumann RM, Bostwick DG. Papillary urothelial neoplasms of low malignant potential. Clinical and biologic implications. Cancer. 1999;86(10):2102–8.

    Google Scholar 

  31. Carbin BE, Ekman P, Gustafson H, Christensen NJ, Sandstedt B, Silfverswärd C. Grading of human urothelial carcinoma based on nuclear atypia and mitotic frequency. I. Histological description. J Urol. 1991;145(5):968–71.

    Google Scholar 

  32. Miyamoto H, Brimo F, Schultz L, Ye H, Miller JS, Fajardo DA, et al. Low-grade papillary urothelial carcinoma of the urinary bladder: a clinicopathologic analysis of a post-World Health Organization/International Society of Urological Pathology classification cohort from a single academic center. Arch Pathol Lab Med. 2010;134(8):1160–3.

    Google Scholar 

  33. Cheng L, Zhang S, MacLennan GT, Williamson SR, Lopez-Beltran A, Montironi R. Bladder cancer: translating molecular genetic insights into clinical practice. Hum Pathol. 2011;42(4):455–81.

    Google Scholar 

  34. van Oers JM, Wild PJ, Burger M, Denzinger S, Stoehr R, Rosskopf E, et al. FGFR3 mutations and a normal CK20 staining pattern define low-grade noninvasive urothelial bladder tumours. Eur Urol. 2007;52(3):760–8.

    Google Scholar 

  35. Oosterhuis JW, Schapers RF, Janssen-Heijnen ML, Pauwels RP, Newling DW, ten Kate F. Histological grading of papillary urothelial carcinoma of the bladder: prognostic value of the 1998 WHO/ISUP classification system and comparison with conventional grading systems. J Clin Pathol. 2002;55(12):900–5.

    Google Scholar 

  36. Holmäng S, Hedelin H, Anderström C, Holmberg E, Busch C, Johansson SL. Recurrence and progression in low grade papillary urothelial tumors. J Urol. 1999;162(3 Pt 1):702–7.

    Google Scholar 

  37. Holmäng S, Hedelin H, Anderström C, Holmberg E, Johansson SL. Prospective registration of all patients in a geographical region with newly diagnosed bladder carcinomas during a two-year period. Scand J Urol Nephrol. 2000;34(2):95–101.

    Google Scholar 

  38. Watts KE, Montironi R, Mazzucchelli R, van der Kwast T, Osunkoya AO, Stephenson AJ, et al. Clinicopathologic characteristics of 23 cases of invasive low-grade papillary urothelial carcinoma. Urology. 2012;80(2):361–6.

    Google Scholar 

  39. Toll AD, Epstein JI. Invasive low-grade papillary urothelial carcinoma: a clinicopathologic analysis of 41 cases. Am J Surg Pathol. 2012;36(7):1081–6.

    Google Scholar 

  40. Brausi M, Witjes JA, Lamm D, Persad R, Palou J, Colombel M, et al. A review of current guidelines and best practice recommendations for the management of nonmuscle invasive bladder cancer by the International Bladder Cancer Group. J Urol. 2011;186(6):2158–67.

    Google Scholar 

  41. Murphy WM, Takezawa K, Maruniak NA. Interobserver discrepancy using the 1998 World Health Organization/International Society of Urologic Pathology classification of urothelial neoplasms: practical choices for patient care. J Urol. 2002;168(3):968–72.

    Google Scholar 

  42. Yorukoglu K, Tuna B, Dikicioglu E, Duzcan E, Isisag A, Sen S, et al. Reproducibility of the 1998 World Health Organization/International Society of Urologic Pathology classification of papillary urothelial neoplasms of the urinary bladder. Virchows Arch. 2003;443(6):734–40.

    Google Scholar 

  43. Bol MG, Baak JP, Buhr-Wildhagen S, Kruse AJ, Kjellevold KH, Janssen EA, et al. Reproducibility and prognostic variability of grade and lamina propria invasion in stages Ta, T1 urothelial carcinoma of the bladder. J Urol. 2003;169(4):1291–4.

    Google Scholar 

  44. Habuchi T, Ogawa O, Kakehi Y, Ogura K, Koshiba M, Hamazaki S, et al. Accumulated allelic losses in the development of invasive urothelial cancer. Int J Cancer. 1993;53(4):579–84.

    Google Scholar 

  45. Eble J.N. SG, Epstein J.I., et al. World Health Organization Classification of Tumours: Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. Lyon, France: IARC Press 2004.

    Google Scholar 

  46. Billis A, Carvalho RB, Mattos AC, Negretti F, Nogueira CR, Oliveira MC, et al. Tumor grade heterogeneity in urothelial bladder carcinoma--proposal of a system using combined numbers. Scand J Urol Nephrol. 2001;35(4):275–9.

    Google Scholar 

  47. Cheng L, Neumann RM, Nehra A, Spotts BE, Weaver AL, Bostwick DG. Cancer heterogeneity and its biologic implications in the grading of urothelial carcinoma. Cancer. 2000;88(7):1663–70.

    Google Scholar 

  48. Bostwick DG, Mikuz G. Urothelial papillary (exophytic) neoplasms. Virchows Arch. 2002;441(2):109–16.

    Google Scholar 

  49. Bircan S, Candir O, Serel TA. Comparison of WHO 1973, WHO/ISUP 1998, WHO 1999 grade and combined scoring systems in evaluation of bladder carcinoma. Urol Int. 2004;73(3):201–8.

    Google Scholar 

  50. Krüger S, Thorns C, Böhle A, Feller AC. Prognostic significance of a grading system considering tumor heterogeneity in muscle-invasive urothelial carcinoma of the urinary bladder. Int Urol Nephrol. 2003;35(2):169–73.

    Google Scholar 

  51. May M, Brookman-Amissah S, Roigas J, Hartmann A, Störkel S, Kristiansen G, et al. Prognostic accuracy of individual uropathologists in noninvasive urinary bladder carcinoma: a multicentre study comparing the 1973 and 2004 World Health Organisation classifications. Eur Urol. 2010;57(5):850–8.

    Google Scholar 

  52. Jones TD, Zhang S, Lopez-Beltran A, Eble JN, Sung MT, MacLennan GT, et al. Urothelial carcinoma with an inverted growth pattern can be distinguished from inverted papilloma by fluorescence in situ hybridization, immunohistochemistry, and morphologic analysis. Am J Surg Pathol. 2007;31(12):1861–7.

    Google Scholar 

  53. Lopez-Beltran A, Cheng L. Histologic variants of urothelial carcinoma: differential diagnosis and clinical implications. Hum Pathol. 2006;37(11):1371–88.

    Google Scholar 

  54. Amin MB, Gómez JA, Young RH. Urothelial transitional cell carcinoma with endophytic growth patterns: a discussion of patterns of invasion and problems associated with assessment of invasion in 18 cases. Am J Surg Pathol. 1997;21(9):1057-68.

    Google Scholar 

  55. Sudo T, Irie A, Ishii D, Satoh E, Mitomi H, Baba S. Histopathologic and biologic characteristics of a transitional cell carcinoma with inverted papilloma-like endophytic growth pattern. Urology. 2003;61(4):837.

    Google Scholar 

  56. Terai A, Tamaki M, Hayashida H, Tomoyosh T, Takeuchi H, Yoshida O. Bulky transitional cell carcinoma of bladder with inverted proliferation. Int J Urol. 1996;3(4):316–9.

    Google Scholar 

  57. Cheng L, Davidson DD, Wang M, Lopez-Beltran A, Montironi R, Wang L, et al. Telomerase reverse transcriptase (TERT) promoter mutation analysis of benign, malignant and reactive urothelial lesions reveals a subpopulation of inverted papilloma with immortalizing genetic change. Histopathology. 2016;69(1):107–13.

    Google Scholar 

  58. Young RH. Papillary and polypoid cystitis. A report of eight cases. Am J Surg Pathol. 1988;12(7):542–6.

    Google Scholar 

  59. Milles G. Catheter-induced hemorrhagic pseudopolyps of the urinary bladder. Jama. 1965;193:968–9.

    Google Scholar 

  60. Ekelund P, Anderström C, Johansson SL, Larsson P. The reversibility of catheter-associated polypoid cystitis. J Urol. 1983;130(3):456–9.

    Google Scholar 

  61. Lane Z, Epstein JI. Polypoid/papillary cystitis: a series of 41 cases misdiagnosed as papillary urothelial neoplasia. Am J Surg Pathol. 2008;32(5):758–64.

    Google Scholar 

  62. Buck EG. Polypoid cystitis mimicking transitional cell carcinoma. J Urol. 1984;131(5):963.

    Google Scholar 

  63. Fromont G, Barcat L, Gaudin J, Irani J. Revisiting the immunophenotype of nephrogenic adenoma. Am J Surg Pathol. 2009;33(11):1654–8.

    Google Scholar 

  64. Rahemtullah A, Oliva E. Nephrogenic adenoma: an update on an innocuous but troublesome entity. Adv Anat Pathol. 2006;13(5):247–55.

    Google Scholar 

  65. Tsuzuki T, Epstein JI. Fibroepithelial polyp of the lower urinary tract in adults. Am J Surg Pathol. 2005;29(4):460–6.

    Google Scholar 

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Zhou, H., Guo, C.C., Ro, J.Y. (2021). Papillary and Inverted Tumors. 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_4

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