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Cancer Grading Manual pp 85–100Cite as

Tumors of the Urinary Bladder

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Abstract

Nearly half of all bladder tumors are noninvasive (stage pTa) papillary neoplasms of urothelial origin. These tumors have been intensively investigated for many decades, and a number of concepts regarding their biologic behavior and prognosis have been well established. Prognosis for these tumors is influenced by tumor size, tumor multifocality, recurrence status, coexistence of carcinoma in situ, and histologic tumor grade [1–6]. The first four elements are straightforward. However, there has been a long-standing lack of agreement among pathologists concerning the ideal system for grading these tumors. A uniform grading system for bladder cancer will allow for valid comparison of treatment results among different centers. The 1973 WHO classification is preferred by some authors because it allows comparison of results between different clinical centers. It is a robust, time-tested, and reasonably reproducible method for pathologic reporting of bladder tumors. The 1998 WHO/ISUP classification of bladder tumors, and its adoption in the 2004 WHO classification, has been the subject of considerable controversy [3, 7–28]. In particular, there is poor interobserver agreement in the diagnostic categories of papillary urothelial neoplasm of low malignant potential (PUNLMP) and low-grade urothelial carcinoma, two new categories in the 2004 WHO system [8, 9, 12, 29–34]. Use of both the 1973 and 2004 WHO classifications (former 1998 ISUP/WHO) has been recommended by some [3, 8, 11, 12, 35–37]. We recently introduced a new four-tiered grading system, which expands previous grading systems to include an additional category of noninvasive papillary carcinomas with exceptionally abnormal cytologic characteristics (Fig. 8.1, Table 8.1) [38]. This new grading system has the combined strengths of both 1973 WHO and 2004 WHO grading system [38].

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Authors and Affiliations

  1. Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA

    Liang Cheng M.D.

  2. Institute of Pathology, Case Western Reserve University, Cleveland, OH, USA

    Gregory T. MacLennan M.D.

  3. Department of Surgery, Unit of Anatomic Pathology, Cordoba University School of Medicine, Cordoba, Spain

    Antonio Lopez-Beltran M.D., Ph.D.

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Editors and Affiliations

  1. School of Medicine, Dept. Pathology, University of Kansas, Rainbow Blvd. 3901, Kansas City, 66160-7410, Kansas, USA

    Ivan Damjanov

  2. School of Medicine, Dept. Pathology, University of Kansas, Rainbow Blvd. 3901, Kansas City, 66160-7410, Kansas, USA

    Fang Fan

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Cheng, L., MacLennan, G.T., Lopez-Beltran, A. (2013). Tumors of the Urinary Bladder. In: Damjanov, I., Fan, F. (eds) Cancer Grading Manual. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-34516-6_8

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