ReviewHandling and Pathology Reporting of Specimens with Carcinoma of the Urinary Bladder, Ureter, and Renal Pelvis☆
Introduction
The urothelium covers the urinary tract, from kidney calyces, renal pelvis, ureter, the urinary bladder, and a variable portion of the urethra. Most carcinomas of these organs are histologically similar [1]. Surgical procedures of these organs provide an important number of specimens in clinical practice [2]. An appropriate assessment of the specimens and reporting of pathological findings may assist urologists in the appropriate management of these patients [2].
The most common bladder specimens are obtained from endoscopic biopsies and transurethral resections of the bladder (TURB), both of which sample subepithelial tissue of varying depth [3]. Other specimens can be obtained from a cystectomy (partial/total), cystoprostatectomy, pelvic exanteration (“en block” resection), and resection of diverticula [3]. Surgical excision of a urachal carcinoma usually includes the bladder dome, urachus, and umbilicus [3]. A bladder biopsy provides information to assess risk factors for recurrence, progression, and response to treatment [4], [5], [6], [7], [8], [9] (Table 1). Small noninvasive papillary neoplasms are often excised by biopsy using cold cup forceps, diathermy forceps, or a small diathermy loop. To avoid tissue distortion, these specimens should be transferred to fixative with minimal handling [2], [3]. Larger neoplasms are often sampled by TURB using a diathermy loop that produces strips of tissue 6 mm in diameter and of variable length [10]. Additional resection of the bladder base after a previous TURB provides additional information on tumor extension. All hyperemic or velvety areas of urothelium are sampled to exclude carcinoma in situ (CIS); random biopsies are commonly taken from macroscopically normal urothelium distant from the tumor site to determine the extent of involvement [11], [12]. Ideally, random samples should be obtained from predetermined sites in four vesical quadrants [11]. Some urologists also submit biopsy specimens of the urethra to assess other areas of the urothelium, particularly in patients with high-grade papillary urothelial carcinoma or CIS [13]. Nephroureterectomy or ureterectomy specimens are the result of cancer in these organs.
This article reviews the handling and pathology reporting of bladder, ureter and renal pelvis specimens with tumor.
Section snippets
Role of the urologist
(1) To provide the pathologist with adequate tissue samples for pathological evaluation.
The diffuse neoplastic involvement of the urothelium may take a number of forms and may signal a prognostically different diathesis depending on the molecular changes that have occurred and how these changes have been expressed pathologically and clinically [9]. This concept has not as yet been practical to factor into standard staging systems. These distinctions, however, have suggested the importance of
Part 1: handling of specimens
Routine protocol-based tissue sampling ensures consistent and thorough examination by trainees and consultants. The issue has been addressed in the last few years by different groups and societies, among which the Association of Directors of Anatomic Pathology and the College of American Pathologists. Lopez-Beltran et al. incorporated the conclusions of each of these contemporary statements to create a standardized approach to examination of tumor specimens obtained from the bladder, ureter and
Acknowledgements
This paper is one of the seven dedicated to standardization of handling and pathology reporting in Uropathology. The additional six deal with adrenal gland, kidney, radical prostatectomy specimens, prostate biopsies, testis and penis. It is based on the Uropathology Workshop held in Sesto Fiorentino (Ely Lilly Italia Headquarter), Florence, Italy, June 15, 2003.
References (37)
- et al.
Factors affecting recurrence and progression in superficial bladder tumors
Eur. J. Cancer
(1995) - et al.
Bladder cancer
Crit. Rev. Oncol. Hematol.
(1998) - et al.
Significance of random bladder biopsies in superficial bladder cancer
Eur. Urol.
(2003) - et al.
Value of immunohistochemistry in staging T1 urothelial bladder carcinoma
Eur. Urol.
(2002) - et al.
Diagnosis and grading of bladder cancer and associated lesions
Urol. Clin. North Am.
(1999) - et al.
Molecular aspects of bladder cancer III. Prognostic markers of bladder cancer
Eur. Urol.
(2002) - et al.
Molecular prognostication in bladder cancer-a current perspective
Eur. J. Cancer
(2003) - Bostwick DG, Lopez-Beltran A. Bladder biopsy interpretation. New York: UPP;...
- et al.
A practical approach to bladder sampling and diagnostic reporting of pathological findings
Pathologica
(2001) - Hruban RH, Wetra WH, Phelps TH, Isacson C. Surgical pathology dissection. An illustrated guide. New York: Springer;...
Long-term follow-up in superficial transitional cell carcinoma of the bladder: prognostic factors for time to first recurrence, recurrence rate, and survival. Final results of a randomized trial comparing doxorubicin hydrochloride, ethoglucid, and transurethral resection alone. EORTC Genitourinary Tract Cancer Cooperative Group
Prog. Clin. Biol. Res.
Pathologic prognostic parameters in bladder urothelial biopsy, transurethral resection, and cystectomy specimens
Semin. Diagn. Pathol.
Classification and grading of the non-invasive urothelial neoplasms: recent advances and controversies
J. Clin. Pathol.
pT1 urothelial carcinoma of the bladder: criteria for diagnosis, pitfalls, and clinical implications
Adv. Anat. Pathol.
Prognosis of bladder cancer. I. Risk factors in superficial transitional cell carcinoma
Eur. Urol.
Intraepithelial lesions of the urinary bladder with a discussion of the histogenesis of urothelial neoplasia
Semin. Diagn. Pathol.
ASCP survey on anatomic pathology examination of the urinary bladder
Am. J. Clin. Pathol.
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This publication is made under the auspices of the European Society of Uropathology (a full section office member of the European Association of Urology, EAU) and the Uropathology Working Group (European Society of Pathology, ESP).