Bladder

Question 1

Posterior bladder wall, young man, post UTI (Trauma, calculi, transplant)

Answer 1

Nephrogenic adenoma.

SMALL TUBULES RESEMBLING RENAL TUBULES

Proliferation of small tubules or papillary fronds or flat architecture- all lined by eosinophilic cuboidal epithelium.

USUALLY RESTRICTED TO SUP LP BUT CAN BE INFILTRATIVE

• Tubules often surrounded by hyalinsed basement membrane, contain eosinophilic secretions)

OR

• Papillary fronds lined by cuboidal eosinophilic cells with occasional “hobnail” features.

No mitotic activity or nuclear pleomorphism

Variable mixed inflammation

Question 2

Nephorgenic adenoma- associations

Presenting complaint:

Cystoscopy findings

Answer 2

Trauma, Cystitis, Calculi, Surgery

Often asymptomatic, can present with haematuria

vague nodularity on mucosal surface and be velvety or polypoid

Question 3

nephorgenic adenoma lining cells

Answer 3

Ususally pink

Can be oxyphilic, clear cells or have signet ring morphology

rare mitoses

Question 4

DDX nephrogenic adenoma

Answer 4

1. prostate and clear cell adeno

• not usually associated with the other conditions
• lining cells are larger, have prominent nucleoli, greater cytologic atypia, higher mitosis

2. low grade Pap urothelial carcinoma

• Papillae are lined by neoplastic looking cells
• Nested or microcystic variant of LGPUC exhibits high atypia/mitoses on the invasive front

3. Capillary hemangioma
   * endothelial marker +, CK 7+

Question 6

IPX bladder

Answer 6

Urothelium is CK7+/20+

Question 7

middle aged man, no sig hx, new onset irritative bladder sx w/wo haematuria

Bladder mucosa

Answer 7

description:

urothelium with variable loss of nuclear polarity with nuclear crowding and atypia but not severe enough to warrant a diagnosis of CIS ie

nuclei- mildly enlarged

chromatin- mildly altered

nuceloli- inconspicous

mitosses - rare

ANSWER IS: UROTHELIAL DYSPLASIA

Question 8

DDX UROTHELIAL DYSPLASIA (3)

Answer 8

1.UROTHELIAL CARCINOMA IN SITU

N - pleomorphic

C - coarse

N - prominent

M - increased with upper level mitoses

2. REACTIVE INFLAMMATORY ATYPIA: presence of acute and chronic inflammation
3. ATYPIA OF UNCERTAIN SIGNIFICANCE: presence of significant atypia in presence of inflamm

Question 9

Von Brunn nests may be involved by urothelial dysplasia

T/F

Answer 9

True

Question 10

lamina propria in urothelial dysplasia

Answer 10

may contian increased inflammation and vascular congestion

Question 11

55 yr old man with with dysuria/frequency/haematuria

Answer 11

UROTHELIAL CIS: a non-papillary ie flat lesion in which th e surface epithelium contains cytologically malignant cells:

N pleomorphic, loss of polarity, crowding

C: hyperchromatic

N; prominent

M: increased and includes high levels

IPX doesn’t differentiated from urothelial dysplasia

Question 12

IPX of both Urothelial dysplasia and CIS

(3)

Answer 12

Aberant CK 20 expression characterised by full thickness cytoplasmic staining (CF normal which is umbrella cells only

P53 overexpression

Ki 67 increased

Question 13

DDX UROTHELIAL CIS

(5)

Answer 13

UROTHELIAL DYSPLASIA

REACTIVE ATYPIA
ATYPIA OF UNCERTAIN SIGNIFICANCE

RADIATION INDUCED ATYPIA

POLYOMA VIRUS INFECTION

Question 14

Histo features radiation induced atypia

Answer 14

•Florid epithelial proliferation with cell enlargement, hyperchromasia, and prominent nucleoli: IE CYTOLOGY IS A GOOD MIMIC FOR CIS

• Stromal fibrosis, subepithelial hemorrhage, and hyalinization of blood vessels