urinary tract




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  • Normal

    • renal pelvis
    • bladder
      • urothelium 3-6 cells thick
      • polarity: organized perpendicular to basement membrane
      • maturation: basal, intermediate, superficial/umbrella cells (mild disorganization is ok)
      • lamina propria (contains strips of muscularis mucosae)
      • muscularis (may contain intramuscular fat)
      • normal females have estrogen induced nonkeratinizing squamous metaplasia in trigone
    • ureter
      • urothelium
      • muscularis
    • urethra
      • epithelium: urothelium (proximal), squamous (distal)
      • stroma

  • Flat urothelial lesions

  • Papillary urothelial lesions

  • Non-neoplastic

  • WHO neoplasms

  • TNM (useful for grossing)

    • bladder
      • Ta: non invasive papillary carcinoma
      • Tis: carcinoma in situ
      • T1: lamina propria invasion (including thin strips of muscularis mucosae)
        • superficial vs deep may be important prognostically
      • T2: muscularis invasion (bladder wall may contain fat)
        • T2a: inner half
        • T2b: outer half
      • T3: perivesical tissue
        • T3a: microscopic
        • T3b: macroscopic
      • T4: local organ invasion
        • T4a: prostate, seminal vesicles, uterus, vagina
        • T4b: pelvic wall, abdominal wall
      • N1: single node <= 2cm
      • N2: single node <= 5cm or multiple nodes
      • N3: any node > 5cm
    • renal pelvis and ureter
      • Ta: non invasive papillary carcinoma
      • Tis: carcinoma in situ
      • T1: lamina propria invasion
      • T2: muscularis invasion
      • T3
        • renal pelvis: peripelvic fat or renal parenchyma invasion
        • ureter: periureteric fat
      • T4: adjacent organs or perinephric fat invasion
      • N1: single node <= 2cm
      • N2: single node <= 5cm or multiple nodes
      • N3: any node > 5cm
    • urethra
      • urethra
        • Ta: non invasive papillary, polypoid or verrucous carcinoma
        • Tis: carcinoma in situ
        • T1: lamina propria invasion
        • T2: corpus spongiosum, prostate, or periurethral muscle invasion
        • T3: corpus cavernosum, beyond prostate capsule, anterior vagina or bladder neck invasion
        • T4: adjacent organ invasion
      • prostatic urethra
        • Tis pu: carcinoma in situ, involving prostatic urethra
        • Tis pd: carcinoma in situ, involving prostatic ducts
        • T1: lamina propria invasion
        • T2: prostatic stroma, corpus spongiosum, or periurethral muscle invasion
        • T3: corpus cavernosum, beyond prostatic capsule, or bladder neck (extra-prostatic extension) invasion
        • T4: adjacent organ (bladder) invasion
      • N1: single node <= 2cm
      • N2: single node > 2cm or multiple nodes

  • Staging

    • bladder
      • 0a: Ta
      • 0is: Tis
      • I: T1
      • II: T2
      • III: T3 or T4a
      • IV: T4b or N1 or M1
    • renal pelvis and ureter
      • 0a: Ta
      • 0is: Tis
      • I: T1
      • II: T2
      • III: T3
      • IV: T4 or N1 or M1
    • urethra
      • 0a: Ta
      • 0is: Tis
      • I: T1
      • II: T2
      • III: T3 or N1
      • IV: T4 or N2 or M1
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