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1:
Benign Urothelium
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Comments: Urothelium normally consists of 4 to 6 layers of cells. The uppermost layer consists of umbrella cells (not well seen in this image) which may have irregular hyperchromatic nuclei.
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2:
Benign Urothelium
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Comments: The urothelial cells are somewhat disorganized in this example, however, they are still clearly benign. The lamina propria is edematous and contains a scattered inflammatory cells.
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3:
Brunn's Nests
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Comments: Brunn’s Nests: Brunn’s nests consist of well-circumscribed clusters of urothelial cells that may or may not be attached to the overlying urothelium. Sometimes they are located deep within lamina propria.
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4:
Brunn's Nests
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Comments: Note the well-circumscribed outlines and lack of cytologic atypia. Brunn’s nests should be distinguished from the nested variant of urothelial carcinoma.
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5:
Hyperplasia of von Brunn nests
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Comments: Florid hyperplasia of von Brunn nests may mimic nested variant of urothelial carcinoma. In von Brunn nest hyperplasia, the nests are large with regular spacing as seen here. In properly oriented biopsies, the nests can be seen extending to the same horizontal level at the base of the proliferation.
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6:
Hyperplasia of von Brunn nest
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Comments: Both nested variant of urothelial carcinoma and florid von Brunn nest hyperplasia (shown here) can lack cytologic atypia. Features supporting nested urothelial carcinoma include: small, crowded nests with variable spacing, infiltrative base, muscularis propria invasion, higher MIB-1 expression. Volmar K, et al. Am J Surg Pathol 2003; 27(9):1243-52.
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7:
Urachal Remnant
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Comments: Urachal remnants are seen in about one-third of adult bladders. Occasionally, the remnant may have dilated chambers and a tortuous course through the bladder. Sectioning through such remnant may result in the appearance seen in this image.
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