UCIS


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  • Clinical

    • age: 50-60s
    • site: bladder, ureter, renal pelvis, prostatic urethra, prostate

  • Histology

    • architecture: flat, discohesive (tend to lift off BM or denude)
    • unequivocal malignant cytology
      • nuclei 5x lymphocyte
      • nuclear atypia: pleomorphism, hyperchromasia
      • frequent mitosis, prominent nucleoli
    • lamina propria with hypervascularization, inflammation, edema

  • Patterns

    • pleomorphic large cell: large and ugly
    • non-pleomorphic large cell: monomorphic large high grade cells, mimicks reactive
    • small cell: smaller, but dark and crowded/overlapping atypical cells
    • clinging: partial denudation with clinging malignant cells
    • pagetoid cancerization: malignant cells scattered in urothelium
    • undermining cancerization malignant cells extending up from base

  • Stains

    • CK20: diffuse, full thickness (vs umbrella cells only in normal)
    • p53: diffuse, full thickness (vs minimal in normal)
    • CD44: absent (vs basal/parabasal in normal)
    • Ki67 not that useful since reactive urothelium has high index of mitosis too

  • Ddx

    • reactive (low grade atypia)
    • therapy effect
    • urothelial atypia of unknown significance (has inflammation, but too much atypia to brush off as reactive)
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