BLADDER HISTOPATHOLOGYDr Dinah Parums, Principal Histopathologist, April 2007

PATHOLOGICAL SIEVE• Infection• Neoplasia

– Benign– Malignant

• Primary• Secondary

• Vascular• Immunological• Trauma• Endocrine• Degenerative• Metabolic• Drugs/Toxins

Anatomy of the Bladder

Normal Bladder Urothelium – Transitional Epithelium

L – lumenEp – EpitheliumLP – Lamina Proprium

Normal Bladder Urothelium – Transitional Epithelium

Dysplastic Urothelium – Transitional Carcinoma In-Situ

Papillary Transitional Cell Carcinoma

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

Bladder Cancer

QuickTime™ and aTIFF (Uncompressed) decompressor

are needed to see this picture.

WHO 2003 Histological Classification of Tumors of the Urinary Bladder

Urothelial tumoursInfiltrating urothelial carcinoma

with squamous differentiation with glandular differentiation with squamous and glandular differentiation Nested variant Microcystic variant Micropapillary variant Lymphoepithelioma-like carcinoma Lymphoma-like variant Plasmacytoid variant Sarcomatoid (w./w.o heterologous elements) Giant cell variant Undifferentiated carcinoma Other variants

WHO 2003 Histological Classification of Tumors of the Urinary Bladder

(contd)

Non-invasive urothelial neoplasiasHyperplasia (flat and papillary)

Dysplasia (include normal urothelium and atypia)Urothelial papilloma Urothelial papilloma, inverted type Non-invasive papillary urothelial neoplasm of LMP Non-invasive papillary urothelial carcinoma (low grade) Non-invasive papillary urothelial carcinoma (high grade)

Squamous neoplasmsSquamous cell carcinoma

Verrucous squamous cell carcinoma Squamous cell papilloma

Glandular neoplasmsAdenocarcinoma

Urachal carcinoma Clear cell adenocarcinoma In situ adenocarcinoma Villous adenoma

WHO 2003 Histological Classification of Tumors of the Urinary Bladder

(contd)

Neuroendocrine tumoursSmall cell carcinoma

Paraganglioma Carcinoid

Mesenchymal and miscellaneous tumoursRhabdomyosarcoma

Leiomyosarcoma Angiosarcoma Osteosarcoma Malignant fibrous histiocytoma Leiomyoma Granular cell tumour Neurofibroma Haemangioma Malignant melanoma Lymphoma

Metastatic tumours and secondary extension

Bladder Cancer - Staging

Bladder Cancer - Staging2002 AJCC/UICC TNM Staging of Bladder Carcinoma

Primary Tumor (T)• TX - Primary tumor cannot be assessed• T0 - No evidence of primary tumor• Ta - Non-invasive papillary carcinoma• Tis - Carcinoma in situ : "flat tumor"• T1 - Tumor invades subepithelial connective tissue• T2 - Tumor invades muscle• pT2a - Tumor invades superficial muscle (inner half)• pT2b - Tumor invades deep muscle (outer half)• T3 - Tumor invades perivesical tissue• pT3a - microscopically• pT3b - macroscopically (extravesical mass)• T4 - Tumor invades any of the following : prostate, uterus, vagina, pelvic wall,

abdominal wall• T4a - Tumor invades prostate, uterus, vagina• T4b - Tumor invades pelvic wall, abdominal wall

Bladder Cancer – Staging (contd)2002 AJCC/UICC TNM Staging of Bladder Carcinoma

Regional Lymph Nodes (N)Regional lymph nodes are those within the true pelvis; all others are distant lymph nodes

• NX - Regional lymph nodes cannot be assessed

• N0 - No regional lymph node metastasis

• N1 - Metastasis in a single lymph node, 2 cm or less in greatest dimension

• N2 - Metastasis in a single lymph node, more than 2 cm but not more than 5 cm in greatest dimension; or multiple lymph nodes, none more than 5 cm in greatest dimension

• N3 - Metastasis in a lymph node, greater than 5 cm in greatest dimension

• Distant Metastasis (M)

• MX - Distant metastasis cannot be assessed

• M0 - No distant metastasis

• M1 - Distant metastasis

Bladder Cancer - Diagnosis

Bladder Cancer - Cytology

Immunohistochemistry in Bladder Cancer

Marker Positivity inUrothelial Carcinoma

High molecular weight cytokeratin(antibody 34bE12) 65%

p63 85%CK7 83-100%CK20 15-74%Thrombomodulin 69-91%Uroplakin III 57%

Of these markers, only Uroplakin III is specific for urothelial differentiation.