Urinary Bladder

Home --> Grading Schema (main page) --> Urinary Bladder

Urinary Bladder

(Click the section headings (in blue) to expand or collapse the content)

Grading of "Transitional Cell Carcinoma"

Grade	Histologic Features ("Transitional Cell Carcinoma")*
1	Closely resemble normal transitional cells. the number of layers > 7; only slight loss of polarity.
2	Cell layers >10; increased mitoses, variable cell size and shape; greater loss of polarity variable chromatin pattern; may be areas of squamous differentiation
3	Barely recognizable as of transitional origin, loosening and fragmentation of superficial ells; occasional giant cells; focal glandular differentiation rnay be presen.
*	This schema is largely replaced by "The WHO/ISUP Consensus Classification of Urothelial Neoplasm".

The WHO/ISUP Consensus Classification of Urothelial Neoplasm

Hyperplasia

Flat hyperplasia: Markedly thickened flat urothelial mucosa without cytologic atypia.

Papillary hyperplasia: Undulating folds of urothelium without cytologic atypia. Prominent vascularity at base of folds only. No discrete papillary fronds.

Flat lesions with atypia

Reactive (inflammatory) atypia: Markedly inflamed urothelium; uniformly nuclear changes; central prominent nucleoli. Mitotic figure at base.

Atypia of unknown significance: despite marked inflammation the cytologic atypia is pronounced with marked nuclear enlargement and huge nucleoli. It is uncertain on the basis of hstology whether the nuclear atypia is purely reactive or it is superimposed on dysplastic cells.

Dysplasia (low-grade intraurothelial neoplasia): Pleomorphic nuclei, and some disorganization. Nuclear enlargement, nuclear hyperchromasia. The findings fall short of carcinoma in situ.

Carcinoma in situ (high-grade intraurothelial neoplasia, includes cases with “severe dysplasla.”): Marked nuclear enlargement and hyperchromasia with prominent nuclear pleomorphism and nuclear irregularity . Numerous prominent nucleoli. Mitotic figure above the basal layer.

Note: The presence of scattered malignant-appearing cells is diagnostic of CIS even without “full thickness” malignancy. An umbrella cell layer can be present in carcinoma in situ.

Papillary neoplasms

Papilloma: Discrete well-developed papillary fronds with an orderly appearance of lining cells with fibrovascular core.

Inverted papilloma

Papillary neoplasm of low malignant potential: Well-developed discrete papillary fronds with orderly arranged urothelium that maintains polarity. Nuclei are uniformly enlarged without pleomorphism. No mitotic figures is identified.

Papillary carcinoma, low-grade: Moderate variation in nuclear size, shape, and chromatic. scattered and hyperchromatic relative to other nuclei. Overall, the appearance with even spacing of uniform cytology.enlarged nuclei showing some nucleoli, Mitotic figures are identified at all levels of the urothelium. Despite mitotic activity, nuclei are relatively uniform both in their polarity and citology. Low grade papillary urothelial carcinoma with an overall orderly array of nuclei. In contrast to tumors of low malignant potential nuclei are hyperchromatic and enlarged with moderate pleomorphism. There are toci with irregularity in cell spacing with some areas of nuclei. Despite some loss of nuclear polarity, the overall arrangement is still that of orderly urotheliurn.

Papillary carcinoma, high-graded with or without marked anaplasla.

fused papillae and nuclear pleomorphism and disorganization even visible at low magnification. marked nuclear pleomorphism and hyperchromatism. disorganized architecture, Cells overlap with lack of polarity. Nuclei show marked variation in size, shape, and chromatin. Some cells are loosely cohesive. nuclei are not oriented perpendicular to the basement membrane. showing multiple markedly enlarged nucleoli and numerous mitotic figures.