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1:
Urothelial Carcinoma - Micropapillary variant
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Comments: This rare variant of urothelial carcinoma consists of delicate filiform or papillary (micropapillary) processes. Note the transition from “conventional” papillary urothelial carcinoma to the micropapillary pattern in this image. Most cases show mixed pattern.
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2:
Urothelial Carcinoma - Micropapillary variant
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Comments: Another example of micropapillary variant of urothelial carcinoma. This is invading the muscularis propria and consists of small clusters of cells surrounded by lacunar spaces. There is superficial resemblance to adenocarcinoma, however there are no true glands.
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5:
Urothelial Carcinoma - Micropapillary variant
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Comments: Micropapillary variant of urothelial carcinoma is an aggressive tumor and shows male predominance. Invasion of lamina propria and muscularis propria is frequently present.
Am J Surg Pathol 1994; 18:1224-1232.
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6:
Urothelial Carcinoma - Nested variant
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Comments: This rare variant of urothelial carcinoma has bland appearance but behaves aggressively. The tumor consists of nests of urothelial cells lacking cytologic atypia proliferating in the lamina propria and even muscularis propria.
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7:
Urothelial Carcinoma - Nested variant
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Comments: Often there is no surface involvement as seen here and in the previous image. This tumor shows male predominance. Its behavior is similar to that of high-grade urothelial carcinoma. Mod Pathol 1996; 9(10):989-994.
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8:
Urothelial Carcinoma - Nested variant
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Comments: Note the absence of cytologic atypia in the tumor cell nests. Deeper aspects of the tumor may be more anaplastic. Differential diagnosis includes Brunn’s nests, cystitis glandularis, nephrogenic metaplasia, inverted papilloma, and urothelial carcinoma with inverted pattern.
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9:
Urothelial Carcinoma - Sclerosing type
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Comments: This variant of urothelial carcinoma is associated with significant desmoplastic response resulting in distortion of tumor cell nests as seen in the photomicrograph
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10:
Urothelial Carcinoma - Sclerosing type
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Comments: Some foci had the appearance of sarcomatoid urothelial carcinoma. The tumor cells have irregular hyperchromatic nuclei and were immunoreactive for epithelial markers.
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11:
Urothelial Carcinoma - Lymphoepithelioma type
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Comments: Lymphoepithelioma-like carcinoma of the bladder consists of high-grade tumor cells with syncytial appearance arranged in sheets and anastomosing nests. There is prominent polyclonal lymphoplasmacytic infiltrate. It may be pure or mixed with conventional urothelial carcinoma.
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12:
Urothelial Carcinoma - Lymphoepithelioma type
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Comments: Tumor cells can be better appreciated at high magnification. This tumor should be distinguished from high-grade urothelial carcinoma with lymphoid stroma, poorly-differentiated squamous cell carcinoma, malignant lymphoma, and chronic cystitis.
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13:
Urothelial Carcinoma - Lymphoepithelioma type
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Comments: The immunostain for cytokeratin (AE1/AE3) highlights the anastomosing clusters of tumor cells. This rare neoplasm appears to be chemosensitive which may permit salvage of bladder function. It is EBV-negative. J Urol Pathol 1993: 1:63-67.
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14:
Urothelial Carcinoma - Glycogen-rich
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Comments: This variant of urothelial carcinoma has abundant cytoplasmic glycogen resulting in clear appearance. Its distinction from clear cell adenocarcinoma is usually not difficult.
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16:
Small Cell Carcinoma
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Comments: Primary small cell carcinoma of urinary bladder is very uncommon comprising less than 0.5% of malignant bladder tumors. Many cases are admixed with areas of conventional urothelial carcinoma. In this photomicrograph, the tumor is infiltrating lamina propria. Surface urothelium is uninvolved.
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17:
Small Cell Carcinoma
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Comments: The tumor infiltrates muscularis propria (same case as previous illustration). The majority of the patients with small cell carcinoma of bladder present at advanced stages. Cancer 1992 Jan; 69(2):527-36
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18:
Small Cell Carcinoma
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Comments: The tumor shows typical small cell features – the tumor cells are arranged in cords or nests, the nuclei display molding and have finely dispersed chromatin, nucleoli are inconspicuous or punctate, and mitotic activity is high. Treatment is usually cystectomy combined with cis-platinum-based chemotherapy. Eur Urol 2001 Jan; 39(1):85-90
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19:
Sarcomatoid Urothelial Carcinoma
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Comments: Sarcomatoid urothelial carcinoma consists of a malignant epithelial component (upper right) and a malignant spindle cell component (lower left). It is more common than primary sarcoma of bladder. It usually presents at advanced stage and has poor prognosis.
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20:
Sarcomatoid Urothelial Carcinoma with Osteoclast-like Giant Cells
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Comments: Osteoclast-type giant cells are occasionally seen in the stroma of urothelial carcinoma. Here they are seen in a sarcomatoid urothelial carcinoma (same case as previous slide). The giant cells are thought to be reactive in nature. Histopathology. 1990 Nov; 17(5):407-11.
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21:
Urothelial Carcinoma - Plasmacytoid Variant
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Comments: The tumor cells in this uncommon variant of urothelial carcinoma closely resemble plasma cells. In this example, the overlying papillary component is partially denuded. Lamina propria shows single cells, small clusters or linear arrays of tumor cells with abundant eosinophilic cytoplasm and enlarged eccentric nucleus.
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22:
Urothelial Carcinoma - Plasmacytoid Variant
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Comments: At high magnification, the plasmacytoid appearance can be easily appreciated. Most cases have co-existing conventional high-grade urothelial carcinoma. At cystoscopy, an exophytic tumor mass may not be visible and the only positive findings may be coarse mucosa with thickening of bladder wall. The outcome is generally poor due to high-grade and high stage at presentation. Mai KT et al, Eur Urol. 2006 Nov; 50(5):1111-4.
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23:
Urothelial Carcinoma - Plasmacytoid Variant
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Comments: Immunohistochemical stains confirm the epithelial differentiation of the tumor cells. In this case, cytokeratin AE1/AE3 and CK7 (shown here) were strongly positive. CK20 was focally positive. Lymphoid markers were negative.
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