Transitional cell carcinoma pathophysiology

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

Pathophysiology

Microscopic Pathology

Urothelial carcinomas have 2 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.

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.
• These rare urothelial carcinomas include the following:

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