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Pathology and Staging: Histopathology and Cytopathology

  • Amber Mackey
  • Farnaz Hasteh
  • Donna E. HanselEmail author
Chapter

Abstract

Bladder cancer can be challenging to diagnose due to the broad morphologic spectrum of both in situ and invasive disease. Histology review of tissue specimens, combined with use of urine cytology, is often optimal to render a diagnosis. In this chapter, we review a range of bladder findings, including normal, in situ, and invasive disease. Both conventional and non-conventional forms of bladder cancer are presented. Discussion of neoplastic mimickers and utility of ancillary testing is incorporated when relevant. We conclude with an overview of cytology findings in bladder neoplasia and highlight the benefits and limitations of this diagnostic modality in bladder cancer.

Keywords

Histology Cytology Urothelial carcinoma Bladder cancer Transitional carcinoma Staging Grading Differential diagnosis Immunostains 

References

  1. 1.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013;63:11–30.PubMedCrossRefGoogle Scholar
  2. 2.
    Renshaw A. Urine and bladder washings. In: Cibas E, Ducatman BS, editors. Cytology diagnostic principles and clinical correlates. 3rd ed. Philadelphia: Saunders Elsevier; 2009. p. 105–27.Google Scholar
  3. 3.
    Hansel DE, Miller JS, Cookson MS, Chang SS. Challenges in the pathology of non-muscle-invasive bladder cancer: a dialogue between the urologic surgeon and the pathologist. Urology. 2013;81(6):1123–30.PubMedCrossRefGoogle Scholar
  4. 4.
    Lopez-Beltran A, Luque RJ, Mazzucchelli R, Scarpelli M, Montironi R. Changes produced in the urothelium by traditional and newer therapeutic procedures for bladder cancer. J Clin Pathol. 2002;55:641–7.PubMedCentralPubMedCrossRefGoogle Scholar
  5. 5.
    Rosai J. Rosai and Ackerman’s surgical pathology. 10th ed. Philadelphia: Elsevier; 2011.Google Scholar
  6. 6.
    Harik LR, O’Toole KM. Nonneoplastic lesions of the prostate and bladder. Arch Pathol Lab Med. 2012;136(7):721–34.PubMedCrossRefGoogle Scholar
  7. 7.
    Young RH. Tumor-like lesions of the urinary bladder. Mod Pathol. 2009;22:S37–52.PubMedCrossRefGoogle Scholar
  8. 8.
    Smith AK, Hansel DE, Jones JS. Role of cystitis cystica et glandularis and intestinal metaplasia in development of bladder carcinoma. Urology. 2008;71(5):915–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Lagwinski N, Thomas A, Stephenson AJ, Campbell S, Hoschar AP, El-Gabry E, Dreicer R, Hansel DE. Squamous cell carcinoma of the bladder: a clinicopathologic analysis of 45 cases. Am J Surg Pathol. 2007;31:1777–87.PubMedCrossRefGoogle Scholar
  10. 10.
    Ozbey I, Aksoy Y, Polat O, Bicgi O, Demirel A. Squamous metaplasia of the bladder: findings in 14 patients and review of the literature. Int Urol Nephrol. 1999;31:457–61.PubMedCrossRefGoogle Scholar
  11. 11.
    Lara HR, Merino C, Coindre JM, Amin M, Pedeutour F, Weiss SW. Pseudosarcomatous myofibroblastic proliferations of the bladder: a clinicopathologic study of 42 cases. Am J Surg Pathol. 2006;30:787–94.CrossRefGoogle Scholar
  12. 12.
    Eble JN, Sauter G, Epstein JI, Sesterhenn IAE. World Health Organization classification of tumours: pathology and genetics of tumours of the urinary system and male genital organs. Lyon: IARC Press; 2004.Google Scholar
  13. 13.
    Amin MB, McKenney JK, Paner GP, Hansel DE, Grignon DJ, Montironi R, Lin O, Jorda M, Jenkins LC, Soloway M, Epstein JI, Reuter VE. ICUD-EAU International Consultation of Bladder Cancer 2012: pathology. Eur Urol. 2013;63:16–35.PubMedCrossRefGoogle Scholar
  14. 14.
    Hodges KB, Lopez-Beltran A, Davidson D, Monitroni R, Cheng L. Urothelial dysplasia and other flat lesions of the urinary bladder: clinicopathologic and molecular features. Hum Pathol. 2010;41(2):155–62.PubMedCrossRefGoogle Scholar
  15. 15.
    Babjuk M, Burger M, Zigeuner R, Shariat SF, van Rhijn BWG, Comperat E, Slvester RJ, Kaasinen E, Bohle A, Redorta JP, Roupret M. EAU Guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2013. Eur Urol. 2013;64(4):639–53. doi: 10.1016/j.eururo.2013.06.003. Epub 2013 Jun 12.PubMedCrossRefGoogle Scholar
  16. 16.
    Nikiforova MN, Nikiforov YE. Molecular anatomic pathology: principles, techniques and application to immunohistologic diagnosis. In: Dabbs D, editor. Diagnostic immunohistochemistry. Philadelphia: Saunders Elsevier; 2010. p. 49–50.Google Scholar
  17. 17.
    Coleman JF, Hansel DE. Utility of diagnostic and prognostic markers in urothelial carcinoma of the bladder. Adv Anat Pathol. 2009;16(2):68–78.CrossRefGoogle Scholar
  18. 18.
    Kamat AM, Hegarty PK, Gee JR, Clark PE, Svatek RS, Hegarty N, Shariat SF, Xylinas E, Scmitz-Drager BJ, Lotan Y, Jenkins LC, Droller M, van Rhijn BW, Karakiewicz PI. ICUD-EAU International Consultation on Bladder Cancer 2012: screening, diagnosis, and molecular markers. Eur Urol. 2013;63:4–15.PubMedCrossRefGoogle Scholar
  19. 19.
    Watts KE, Montironi R, Mazzucchelli R, van der Kwast T, Osunkoya AO, Stephenson AJ, Hansel DE. Clinicopathologic characteristics of 23 cases of invasive low-grade papillary urothelial carcinoma. Urology. 2012;80:361–6.PubMedCrossRefGoogle Scholar
  20. 20.
    Hansel DE, Zhang Z, Petillo D, Teh BT. Gene profiling suggests a common evolution of bladder cancer subtypes. BMC Med Genomics. 2013;6:42.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Zhong M, Gersbach E, Rohan SM, Yang XJ. Primary adenocarcinoma of the urinary bladder: differential diagnosis and clinical relevance. Arch Pathol Lab Med. 2013;137(3):371–81.PubMedCrossRefGoogle Scholar
  22. 22.
    Thomas AA, Stephenson AJ, Campbell SC, Jones JS, Hansel DE. Clinicopathologic features and utility of immunohistochemical markers in signet-ring cell adenocarcinoma of the bladder. Hum Pathol. 2009;40:108–16.PubMedCrossRefGoogle Scholar
  23. 23.
    Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer; 2010.Google Scholar
  24. 24.
    Paner GP, Brown JG, Lapetino S, Nese N, Gupta R, Shen SS, Hansel DE, Amin MB. Diagnostic use of antibody to smoothelin in the recognition of muscularis propria in transurethral resection of urinary bladder tumor (TURBT) specimens. Am J Surg Pathol. 2010;34:792–9.PubMedCrossRefGoogle Scholar
  25. 25.
    Hansel DE, Paner GP, Nese N, Amin MB. Limited smoothelin expression within the muscularis mucosae: validation in bladder diverticula. Hum Pathol. 2011;42:1770–6.PubMedCrossRefGoogle Scholar
  26. 26.
    Hansel DE, Amin MB, Comperat E, Cote RJ, Knuchel R, Montironi R, Reuter VE, Soloway MS, Umar SA, Van der Kwast TH. A contemporary update on pathology standards for bladder cancer: transurethral resection and radical cystectomy specimens. Eur Urol. 2013;63:31–2.CrossRefGoogle Scholar
  27. 27.
    Demay RM. Urine. In: Demay RM, editor. The art & science of cytopathology. 2nd ed. ASCP: Chicago, IL; 2012. p. 436–89.Google Scholar
  28. 28.
    Rosenthal DL, Raab SS. Cytologic detection of urothelial lesions, essentials in cytopathology series, vol II. New York: Springer; 2006.Google Scholar
  29. 29.
    Dimashkeih H, Wolff DJ, Smith TM, Houser PM, Nietert PJ, Yang J. Evaluation of UroVysion and cytology for bladder cancer detection: a study of 1835 paired urine samples with clinical and histologic correlation. Cancer Cytopathol. 2013;121(10):591–7. doi: 10.1002/cncy.21327. Epub 2013 Jun 25.CrossRefGoogle Scholar
  30. 30.
    Smith GD, Wilson A, Gopez EV, Tripp SR, Pasi A. A retrospective review of UroVysion FISH interpretations over 8.6 years: a major shift in the patient test population. Diagn Cytopathol. 2012;41(5):437–47.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  1. 1.Department of PathologyUniversity of California at San DiegoLa JollaUSA
  2. 2.Department of PathologyUniversity of California at San DiegoLa JollaUSA

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