Papillary urothelial carcinoma, invasive (urinary bladder)
This 93 year-old man presented with haematuria. Rigid cystoscopy was performed, and a biopsy sent to pathology.
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The sections show multiple pieces of partly necrotic urothelium with heat artefact, diffusely infiltrated by tumour showing a variably papillary, solid and nested architecture. There is architectural disarray. Neoplastic cells show enlarged, pleomorphic and hyperchromatic nuclei and a moderate amount of cytoplasm. There are abundant mitotic figures and there is prominent apoptotic debris. Widespread invasion of lamina propria is present, and focally, tumour is seen to dissect between smooth muscle bundles, suspicious for muscularis propria involvement. Definitive lymphovascular space invasion is not seen. The specimen contained no flat urothelium for assessment of carcinoma in situ.
Of note, a second, 'deep' specimen was also received, which showed thick smooth muscle bundles in keeping with muscularis propria. This showed no evidence of malignancy / tumour involvement. Given the patient's advanced age, the surgical team opted for a surveillance approach, aiming for symptom control, rather than pursuing more aggressive surgical options.
- Cheng L, Montironi R, Davidson DD, Lopez-Beltran A. Staging and reporting of urothelial carcinoma of the urinary bladder. Mod Pathol. 2009 Jun;22 Suppl 2:S70-95. Free full article