Transitional cell carcinoma pathophysiology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Pathophysiology

Gross Pathology

Urothelial carcinomas have two main growth patterns:

• Papillary urothelial carcinomas:
  • Have slim finger-like projections that grow from the lining of the renal pelvis or ureter into the cavity.
• Flat urothelial carcinomas:
  • Lay flat in the lining of the renal pelvis and ureter.
  • They grow deeper into the layers of the wall of the renal pelvis or ureter rather than into its cavity.

Microscopic Pathology

Non-invasive urothelial carcinoma

Non-invasive urothelial carcinomas are only in the lining of the renal pelvis or ureter and have not grown deeper into the wall of the renal pelvis or ureter. Types of non-invasive urothelial carcinomas include:

• Non-invasive flat urothelial carcinoma
• Non-invasive papillary urothelial carcinoma, high grade
• non-invasive papillary urothelial carcinoma, low grade
• Non-invasive papillary urothelial neoplasm of low malignant potential (which means there is only a small chance that it will become invasive cancer)

Invasive urothelial carcinoma

• Invasive urothelial carcinomas grow from the lining of the renal pelvis or ureter into the deeper layers of the renal pelvis or ureter wall, such as lamina propria and muscularis.
• Urothelial carcinomas with mixed epithelial features are invasive tumors that have different types of cells mixed with the cancer cells.
• They occur less often than typical invasive urothelial carcinomas and are generally considered to be more aggressive.
• The following table illustrates the findings on microscopic analysis for the subtypes of invasive transitional cell carcinoma:

Subtype	Description
Urothelial carcinomas with squamous differentiation	Have urothelial and squamous cells Observed in 44% of renal pelvis tumors
Urothelial carcinomas with glandular differentiation	Have gland cells, and there are spaces between the gland cells
Micropapillary urothelial carcinomas	Have micropapillae High grade neoplasm
Sarcomatoid urothelial carcinomas	Have cells that look like sarcoma This aggressive carcinoma has often spread to lymph nodes and organs other than the renal pelvis or ureter when it is diagnosed
Nested variant of urothelial carcinomas	Have nests, which are groups of anaplastic cells with large nuclei Very rare but aggressive
Microcystic urothelial carcinomas	Have cysts in them that can range in size from microscopic to 2 mm Very rare
Lymphoepithelioma-like urothelial carcinomas	Have lymphatic tissue mixed with urothelial cells, or transitional cells Very rare carcinoma More common in men than women
Plasmacytoid and lymphoma-like urothelial carcinomas	Have tumor cells that look like lymphoma or plasmacytoma
Giant cell urothelial carcinomas	Have abnormally large cells with more than one nucleus.
Clear cell urothelial carcinomas	Have clear cells (cells with clear cytoplasm and a large nucleus).
Lipid cell variant of urothelial carcinomas	Have cells that are filled with fat
Undifferentiated variant of urothelial carcinomas	Have cells that don’t have any clear features and don’t look like any other type of cell (they are undifferentiated).
Urothelial carcinomas with trophoblastic differentiation	Have cells that look like trophoblasts Trophoblast cells form the tissue that becomes the placenta and the membranes that surround the embryo.

Grading

According to the WHO grading criteria, there are three grades of transitional cell carcinoma based on the degree of cellular differentiation:

Grade	Description
Grade 1	Tumors with the least degree of cellular anaplasia compatible with a diagnosis of malignancy
Grade 2	Histologic features between grades 1 and 3
Grade 3	Tumors with the most severe degrees of cellular anaplasia