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Urothelial and Urethral Cancer
Published in Karl H. Pang, Nadir I. Osman, James W.F. Catto, Christopher R. Chapple, Basic Urological Sciences, 2021
Ibrahim Jubber, Karl H. Pang, James W.F. Catto
Two classifications are used for grading UCC.The World Health Organization (WHO) 1973 classification:Well (Grade 1), moderately (Grade 2) and poorly differentiated (Grade 3).The WHO 2004 classification (papillary lesions):Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP).Low grade (LG).High grade (HG).G1 tumours split into PUNLMP and LG.G2 reassigned to LG and HG.G3 reassigned to HG.
Bladder Cancer
Published in Dongyou Liu, Tumors and Cancers, 2017
Tumors affecting the urinary tract consist of eight categories: (1) urothelial tumors (infiltrating urothelial carcinoma [with squamous differentiation, with glandular differentiation, with trophoblastic differentiation, nested, microcystic, micropapillary, lymphoepithelioma-like, lymphoma-like, plasmacytoid, sarcomatoid, giant cell, and undifferentiated] and noninvasive urothelial neoplasias [urothelial carcinoma in situ, noninvasive papillary urothelial carcinoma—high grade, noninvasive papillary urothelial carcinoma—low grade, noninvasive papillary urothelial neoplasm of low malignant potential, urothelial papilloma, and inverted urothelial papilloma]), (2) squamous neoplasms (squamous cell carcinoma [SCC], verrucous carcinoma, and squamous cell papilloma), (3) glandular neoplasms (adenocarcinoma [enteric, mucinous, signet ring cell, and clear cell] and villous adenoma), (4) neuroendocrine tumors (small cell carcinoma, carcinoid, and paraganglioma), (5) melanocytic tumors (malignant melanoma and nevus), (6) mesenchymal tumors (rhabdomyosarcoma, leiomyosarcoma, angiosarcoma, osteosarcoma, malignant fibrous histiocytoma, leiomyoma, and hemangioma), (7) hematopoietic and lymphoid tumors (lymphoma and plasmacytoma), and (8) miscellaneous tumors (carcinoma of Skene, Cowper, and Littre glands; metastatic tumors and tumors extending from other organs) [1].
Transitional Cell Carcinoma of the Bladder
Published in Anthony R. Mundy, John M. Fitzpatrick, David E. Neal, Nicholas J. R. George, The Scientific Basis of Urology, 2010
T. R. Leyshon Griffiths, Nick Mayer
For more than three decades the preferred grading system in the United Kingdom for invasive and non-invasive TCC has been the World Health Organization (WHO) 1973 classification (21), which has been repeatedly validated and shown to be of clinical relevance for treatment and prognosis. WHO 1973 divides TCC into three grades on the basis of cytological and architectural disorder: grade 1 being well differentiated, grade 2 moderately differentiated, and grade 3 poorly differentiated. However, the classification has been criticized for imprecise definitions, resulting in poor reproducibility between pathologists and for having the majority of tumors in the middle grade (grade 2), which as a group therefore shows considerable variability in clinical behavior. In 1998, the WHO/International Society of Urological Pathology (ISUP) consensus classification was published by a group of expert uropathologists (22), notably without input from urologists, which was intended to replace the original WHO 1973 classification. The 1998 classification has subsequently been adopted in the most recent WHO 2004 classification (23). The main differences are two grades of carcinoma (high grade and low grade) in the WHO 2004 classification and the introduction of the term papillary urothelial neoplasm of low malignant potential, to replace the best differentiated grade 1 tumors, avoiding the term carcinoma for tumors with low risk of either recurrence or progression (Fig. 1). However, there has been considerable resistance in the United Kingdom to adopting the WHO 2004 classification, which was not prospectively validated prior to its introduction and has subsequently not demonstrated either improved reproducibility or clinical relevance over WHO 1973 (25). A particular uncertainty is whether all patients in the high-grade group will benefit from intravesical BCG therapy or be exposed to unnecessary side effects. Current reporting guidelines therefore recommend providing the urologist with both classifications (26,27).
Cystoscopic surveillance of patients with non-muscle-invasive bladder cancer revisited
Published in Scandinavian Journal of Urology, 2020
For many urologists it was unsatisfying to give a cancer diagnosis to a group of mostly younger patients with a ‘benign’ tumor. That was one reason for the introduction of the entity papillary urothelial neoplasm of low malignant potential (PUN-LMP) in 1998. In a regional Swedish study with central pathology assessment they accounted for 26% of all Ta tumors [5]. With a follow-up of at least 5 years their recurrence rate was half of the rest of the Ta group and none progressed The authors consequently concluded that this sub classification seemed to add valuable prognostic information. Unfortunately, the introduction of PUN-LMP has not been much adopted and in the most recent Swedish register <2% were classified in that way. After that time, they are not separately registered because of their scarcity. A similar decrease has been found in an international study and based on their results with the similar prognosis for PUN-LMP and Ta-LG carcinomas they propose to stop using PUN-LMP as a separate grade category [6].
National incidence and survival of patients with non-invasive papillary urothelial carcinoma: a Danish population study
Published in Scandinavian Journal of Urology, 2018
Marie Schmidt Erikson, Astrid Christine Petersen, Klaus Kaae Andersen, Anne Helms Andreasen, Søren Friis, Karin Mogensen, Gregers Gautier Hermann
Data on all Danish residents with primary urothelial neoplasia in the bladder from 1 January 2000 to 31 December 2010 were included and followed until 1 January 2016. Patients with urothelial papilloma (n = 88) or primary low grade urothelial dysplasia (n = 55) were excluded. The population were divided into sub-groups of Ta LG, Ta HG, CIS and invasive carcinomas (stage T1–T4). Patients with papillary urothelial neoplasm of low malignant potential (PUNLMP) (n = 985) were categorized as Ta LG. Patients with Ta LG and concomitant CIS (n = 111) or Ta HG and CIS (n = 125) were categorized as Ta HG. In total, 17,941 patients diagnosed with primary urothelial neoplasia with a total observation time of 133,920 years (Table 2) were included for statistical analysis.
Assessment of CEP55, PLK1 and FOXM1 expression in patients with bladder cancer in comparison with healthy individuals
Published in Cancer Investigation, 2018
Saman Seyedabadi, Massoud Saidijam, Rezvan Najafi, Seyed Habibollah Mousavi-Bahar, Mohammad Jafari, Sajjad MohammadGanji, Ali Mahdavinezhad
In this study, 72 tissue samples from 36 patients with BC (36 from malignant site and 36 from adjacent urothelium) and 20 normal bladder tissues from BPH affected patients were studied. Average age of patients was 71 ± 10 y. Ten patients had history of carcinogens exposure, such as asbestos and active chemical colors. The others (26 persons) were not exposed to such substances. All samples were assessed by two expert pathologists and were diagnosed of transitional cell carcinoma. According to pathology results, 13 of 36 patients were diagnosed as muscle invasive BC (MIBC) and the others were NMIBC. The grading of tumor classification was as follows: Papillary Urothelial Neoplasm of Low Malignant Potential (PUNLMP) (two cases), Low grade (17 cases) and high grade (17 cases). All patients were followed up every 3 m by urine cytology and ultrasonography until August 2016. Transurethral resection was applied in the following conditions: abnormal cytology or suspected lesion in ultrasonography. Median follow-up duration was 30 m (range: 20–36 m). Average time of recurrence was 14 m (range: 4–30 m). Recurrence was observed in 16 cases as well as 4 deaths in patients.