Which histologic findings are characteristic of urothelial carcinoma (transitional cell carcinoma)?

Updated: Apr 03, 2019
  • Author: E Jason Abel, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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At a consensus conference, pathologists of the WHO and ISUP preferred the name urothelial carcinoma to describe tumors formerly known as transitional cell carcinoma. [22] Histopathology is used to grade bladder cancer tumors. Although no uniform grading system exists, most grading systems are based on the degree of anaplasia of the tumor cells. Tumor grade strongly correlates with stage and prognosis. The most commonly accepted system [22] is presented below.

  • Papilloma (former grade 0) - Fewer than 7 epithelial cell layers and no abnormalities in histology, these tumors are considered benign

  • Papillary urothelial tumors of unknown malignant potential (former grade I) - Well-differentiated thin fibrovascular stalks with a thickened urothelium that contain more than 7 cell layers and exhibit slight anaplasia and pleomorphism; possible increased nuclear-to-cytoplasmic ratio and prominence of nuclear membrane; rare mitotic figures, some association with higher concurrent tumors

  • Low grade urothelial carcinoma (former grade II) - Moderately differentiated, wider fibrovascular core, greater cell disturbance with loss of cellular polarity, higher nuclear-to-cytoplasmic ratio, nuclear pleomorphism and prominent nucleoli, and more frequent mitotic figures

  • High grade urothelial carcinoma (former grade III) - Poorly differentiated, marked pleomorphism, high nuclear-to-cytoplasmic ratios, and frequent mitotic figures; cells that remain undifferentiated from basement membrane to surface

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