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Case 1 - Discussion

Surgical Pathology Case

 

CK7, 20 CK20, 20
CD10, 20 Vimentin, 20
 
RCC,20  

Diagnosis: Metastatic High-Grade Urothelial Carcinoma

 

Urothelial (Transitional Cell) Neoplasms

 

Papillary Urothelial Neoplasm

 of Low Malignant Potential

 Urothelial Carcinoma

Low Grade

Urothelial Carcinoma

High Grade

 Architecture

Delicate, papillary, preserved architecture

Papillary, fused, branching, loose clusters

Fused, papillary, flat, nodular or isolated

 Cell Organization

Even, not dense, cohesive, ordered

Mainly even, cohesive, ordered

Slightly dense, loss of order 

Often disordered, loss of polarity, dyscohesive

 Umbrella Cells

Well preserved

Partially preserved

Often not present

 Cell Number

Normal or slightly increased

Often numerous

Variable

 Cell Size

Increased, uniform

Increased, uniform

Increased, pleomorphic

 Cell boarder

Moderately distinct

Indistinct

Indistinct

 Cytoplasm

Reduced cytoplasmic clearing

Homogeneous, no cytoplasmic clearing

Variable, common vacuolization

 N/C Ratio

Increased

Increased

Increased

 Nuclei

 

 

 

     Position

Perpendicular orientation, eccentric

Eccentric

Eccentric

     Size

Maybe uniformly enlarged

Enlarged with slight variation in size

Enlarged with variation in size

     Morphology

Round,  elongated or oval, uniform

Round or slightly pleomorphic

Moderate-marked pleomorphism

     Border

Regular or irregular

Irregular

Irregular

 Chromatin

Evenly dispersed and finely granular

Evenly dispersed, mild variation

Hyperchromasia, coarse granularity

 Nucleoli

Small or absent.

Inconspicuous or large

Variable, often prominent

 Mitosis

Present, but not numerous, basal

Maybe common, not important

Common and abnormal

 Behaviors

No invasion or metastasis

Can invade but rarely metastasize

Often infiltrate

 Histology

 

 

 

    Lower power

PUNLMP (AFIP, series 4)

Urothelial carcinoma, low grade  (AFIP, series 4)

Urothelial carcinoma, high grade  (AFIP, series 4)

    Higher power

PUNLMP (AFIP, series 4)

Urothelial carcinoma, low grade  (AFIP, series 4)

Urothelial carcinoma, high grade  (AFIP, series 4)

 Cytology

PUNLMP (AFIP, series 4)

Urothelial carcinoma, low grade  (AFIP, series 4)

Urothelial carcinoma, high grade  (AFIP, series 4)

 

Summarized by: Zenggang Pan, MD, PhD

REFERENCES

 

  • Rosai and Ackerman's Surgical Pathology, 9th edition

  • AFIP, tumor of the kidney, bladder and related urinary structures, series 4