Elsevier

European Urology

Volume 45, Issue 3, March 2004, Pages 257-266
European Urology

Review
Handling and Pathology Reporting of Specimens with Carcinoma of the Urinary Bladder, Ureter, and Renal Pelvis

https://doi.org/10.1016/j.eururo.2003.09.018Get rights and content

Abstract

Objective: Pathologists play a pivotal role in the diagnosis and in the report of the pathological features related to prognosis.

Methods: To meet these endpoints, the following issues must be accomplished: adequate information about the patient history, proper handling of the specimens, identification of the reliable histopathological techniques necessary to reach the more detailed diagnostic information and evaluate the prognostic variables, and a standardized pathological report.

Results: Recent efforts to standardize the histopathological evaluation have generated significant confusion among the urological and pathological communities as well. No consensus has been achieved about the optimal pathological grading of urothelial tumors, to date.

Conclusion: A proposal for standardization of sampling and reporting of the urothelial tissues achieved within Uropathology follows. The urologists have a great role in assisting pathologists in the proper examination by providing them with clinical information.

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.

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  • Cited by (0)

    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).

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