Urinary Bladder

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Urinary Bladder: Click sections headings below (in blue) to expand or collapse the content

Diagnostic Headings (i.e. specimen & procedure)

Diagnostic Headings
	Urinary bladder, dome / trigone, biopsy:
	Urinary bladder, left / right wall, biopsy:
	Urinary bladder, transurethral resection:
	Urinary bladder, ___, transurethral resection:
	Urinary bladder, ___ , biopsy:

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Dx. Menu -- Wording of Common Abnormalities

This subsection lists key diagnostic line for the most common diseases in this organ / system. Copy the relevant line(s) by clicking on the button and paste to your report to construct your own report.

Normal and Nearly Normal:

-- No diagnostic abnormality.

-- No urothelial dysplasia or carcinoma.

-- Denuded bladder mucosal with minimal inflammation.

Inflammation:

-- Moderate chronic inflammation and reactive urothelial atypia.

-- Interstitial cystitis with increased mast cells (> 7 / HPF) in detrusor muscle.

-- Moderate acute inflammation with multinucleated giant cell reaction.

Neoplastic:

-- Papillary urothelial carcinoma, low-grade, non-invasive, present in all microscopic fragments, superficial biopsy.

-- Focal urothelial carcinoma in situ (CIS).

Normal or Minimal Changes

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Clinical scenario: .

Urinary bladder, left wall, biopsy:

-- No diagnostic abnormality.

Slides examined: H&E x 2

CPT code: 88305 x 1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario: .

Urinary bladder, trigone, biopsy:

-- Benign bladder mucosa with minimal chronic inflammation and reactive urothelial atypia.

-- No dysplasia or carcinoma is identified.

Slides examined: H&E x 2

CPT code: 88305 x 1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario: .

Urinary bladder, dome, biopsy:

-- Largely denuded urothelial mucosa with minimal inflammation.

-- No granuloma, urothelial dysplasia or carcinoma.

Slides examined: H&E x 2

CPT code: 88305 x 1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

Papillary Urothelial Carcinomas -- Biopsy

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Clinical scenario:

Urinary bladder, transurethral resection:

-- Papillary urothelial carcinoma, low-grade, non-invasive, present in all microscopic fragments, superficial biopsy.

-- Chronic cystitis with prominent dystrophic mucosal calcification.

-- No detrusor muscle is identified in this biopsy.

Slides examined: H&E x 2

CPT code: 88305 x 1

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Clinical scenario: .

Urinary bladder, trigone, biopsy:

-- Low-grade papillary urothelial carcinoma (conventional TCC-2).

-- No stromal invasion is identified.

-- Detrusor muscle is present and is free of tumor.

Slides examined: H&E x 2

CPT code: 88305 x 1

Editor's comment:

It is not uncommon to encounter cases with limited sample that seem to fall between low-grade and high-grade. Most urologists seem to accept the TCC-2 of the old grading schema as supplemental information in pathology report.

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Clinical scenario: .

Urinary bladder, left wall, biopsy:

-- High-grade papillary urothelial carcinoma, non-invasive.

-- No detrusor muscle is identified in this biopsy.

Slides examined: H&E x 2

CPT code: 88305 x 1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario: .

Urinary bladder, left wall, transurethral resection:

-- High-grade papillary urothelial carcinoma, constituting at least 70% of the specimen, with focal marked crush/cautery artifact, highly fragmented.

-- No definite stromal invasion is identified.

-- Large fragments of detrusor muscle are present and are free of the tumor.

Slides examined: H&E x 2

CPT code: 88305 x 1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario: .

Urinary bladder, transurethral resection:

-- Poorly differentiated invasive urothelial carcinoma widely infiltrating muscularis propria, present in five large (muscular) fragments (3-4 mm in size).

-- High grade urothelial carcinoma in-situ, micropapillary type, at least 5 mm in horizontal span.

-- No definite angiolymphatic invasion.

Slides examined: H&E x 3

CPT code: 88305 x 1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario: .

Urinary bladder, biopsy:

-- Invasive high-grade urothelial carcinoma,. constituting at least 80% of the specimen with focal tumor necrosis and extensive invasion into muscularis propria.

Note: 02958203.

Slides examined: H&E x 3

CPT code: 88305 x 1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Urinary bladder, left anterior wall, transurethral resection:

-- Invasive papillary urothelial carcinoma, high grade, present in all fragments, constituting 80% of specimen.

-- Detrusor muscle is present and is involved by the invasive carcinoma.

-- No angiolymphatic invasion.

Slides examined: H&E x 3

CPT code: 88305 x 1

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

Papillary Lesions of Uncertain Natures

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Clinical scenario: .

Urinary bladder, dome, biopsy:

-- Papillary urothelial neoplasm of low malignant potential (PUNLMP) (see note).

Note: Sections reveal an unequivocal papillary urothelial neoplasm characterized by increased cell layers, disarray of the cell alignment, variation of nuclear size, rare mitotic figures and complete surface "umbrella cells". The main differential diagnosis include low-grade non-invasive papillary urothelial carcinoma vs. papillary urothelial neoplasm of low malignant potential (PUNLMP). The case is reviewed by two other pathologists and the interobserver variability reflects the diagnostic challenge although the combine clinical and histologic findings favor the above diagnosis of "PUNLMP".

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario: .

Urinary bladder, dome, biopsy:

-- Focal papillary hyperplasia.

-- No active inflammation, urothelial dysplasia or carcinoma.

Invasive Urothelial Carcinoma -- Cystectomy

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Clinical scenario: .

Urinary bladder and prostate, cystoprostatectomy:

Urinary bladder:

-- Invasive high-grade papillary urothelial carcinoma (see Tumor Synopsis )

-- Focal acute and chronic inflammation with fibrosis, probably previous biopsy / procedure site changes.

-- All resection margins are free of the tumor.

Prostate

-- Focal prominent chronic inflammation.

-- No high-grade prostatic intraepithelial neoplasia or prostatic adenocarcinoma.

-- No high-grade urothelial dysplasia or carcinoma in prostatic urethra.

Slides examined: H&E x X

CPT code: 8830X x X

Editor's comment:

To prepare "Synoptic Report" with an on-line tool, go to Home page and click on Tumor Reporting. It usually takes less than 30% of the time required by routine dictation method.

Urothelial Cacinoma in-situ (CIS) -- Biopsy

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Clinical scenario: .

Urinary bladder, transurethral resection:

-- Urothelial carcinoma in-situ with glandular differentiation, 2 mm in horizontal span.

-- No definitive stromal invasion.

-- Detrusor muscle is present and is free of the tumor.

Slides examined: H&E x X

CPT code: 8830X x X

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

Inflammation - Cystitis

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Clinical scenario:

Urinary bladder, biopsy:

-- Largely denuded mucosa with marked chronic inflammation and lymphoid aggregates (follicular cystitis).

-- Prominent (detrusor) hypertrophic muscle.

-- No urothelial dysplasia or carcinoma.

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario: .

Urinary bladder, biopsy:

-- Diffuse prominent chronic cystitis.

-- No urothelial dysplasia or carcinoma.

-- No detrusor muscle is present in this biopsy.

Slides examined: H&E x X

CPT code: 8830X x X

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario:

Urinary bladder, biopsy:

-- Partially healed/re-epithelialized mucosal erosion with granulation tissue and prominent acute and chronic inflammation.

-- No muscularis propria is present for evaluation of possible interstitial cystitis.

-- No granuloma, urothelial dysplasia or carcinoma.

Note: 02958203.

Slides examined: H&E x X

CPT code: 8830X x X

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

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Clinical scenario: .

Urinary bladder, biopsy:

-- Prominent acute and chronic inflammation with multiple epithelioid granulomas consistent with BCG treatment effect.

-- No urothelial dysplasia or carcinoma.

-- Detrusor muscle is present focally and with no diagnostic abnormality.

Note: 02958203.

Slides examined: H&E x X

CPT code: 8830X x X

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

Cystitis of Special Types

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Clinical scenario: 56-yo woman with urinary loverflow incontinence. ? interstitial cystitis?

Urinary bladder, biopsy:

-- Severe eosinophilic cystitis, acute phase, >100 eosinophils/HPF, etiology uncertain.

-- No mucosal erosion, granuloma or prominent stromal fibrosis (chronic phase).

-- No urothelial dysplasia or carcinoma.

Note: Eosinophilic cystitis is not a distinct etiologic diagnosis but rather represents a tissue response to a wide variety of causes. Clinical correlation, therefore, is required for the underlying cause.

Slides examined: H&E x X

CPT code: 8830X x X

Editor's comment:

In the absence of clinical signs / symptoms, other causes must be excluded, esp. in mild or late cases.

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Clinical scenario: 49-year old woman with urinary retention, overflow incontinence and poor bladder compliance.

Urinary bladder, excisional biopsy:

-- Moderate to severe eosinophilic cystitis with focal mucosal necrosis and eosinophilic abscess, etiology uncertain (see note).

-- No significant mural fibrosis, significant lymphoplasmacytosis or fungal organism is identified.

-- No urothelial dysplasia or carcinoma.

Note: The constellation of markedly increased eosinophils with eosinophilic abscess, mucosal necrosis and focal fibrosis in the setting of urinary retention, overflow incontinence and poor bladder compliance in this patient is consistent with severe eosinophilic cystitis. Eosinophilic cystitis, however, is not a distinct etiologic diagnosis but rather represents a tissue response to a wide variety of causes. Clinical correlation, therefore, is required for the underlying cause. .

Slides examined: H&E x X

CPT code: 8830X x X

Editor's comment:

Eosinophilic cystitis is a combined clinical-histological diagnosis. Definitive diagnosis, esp. when mild or in late stage, requires clinical indication, and exclusion of other causes such as infection and Langerhan histiocytosis.

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Clinical scenario: .

Urinary bladder, excisional biopsy:

-- Increased mast cells in muscularis propria (up to 30/hpf), compatible with clinical impression of interstitial cystitis.

-- Denuded urinary bladder mucosa with superficial diffuse mild chronic inflammation.

Slides examined: H&E x X

CPT code: 8830X x X

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

Inverted Papillomas

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Clinical scenario: .

Organ, site, surgical procedure:

-- Inverted papilloma.

-- No urothelial dysplasia or carcinoma.

Slides examined: H&E x X

CPT code: 8830X x X

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.

Other Lesions

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Clinical scenario: .

Organ, site, surgical procedure:

-- Dx Heading above font = 04Heading; Style = 04DxHeadings.

Note: 02958203.

Slides examined: H&E x X

CPT code: 8830X x X

Editor's comment:

This section critics on the pro & con of the the wording. There will be 12-pt space after text paragraph.