BLADDERDr Frances McCormick

Derriford Hospital

Anatomy

Specimens

• Cytology• Biopsy, TURBT• Cystectomy, partial or radical• Anterior exenteration

Handling1

• Cytology – 2 pap slides.• Biopsies – all embedded, 3 levels.• TURBT – depends on quantity of chippings

(Fractionated resection).

Handling2

• Partial cystectomy• Radical cystectomy

- female, female adnexae and ant vagina

- male, prostate and seminal vesicles

Anterior exenteration - +AP resection

Name and Classificiation

Is it neoplastic?

• If it is a flat lesion?

• If it is a papillary lesion?

Flat Lesions

• Inflammatory• Dysplastic• CIS• ? denuded

Is it CIS?

Does Immuno help?

• Cytokeratin 20• CD44/cyt5• MIB1• p53

Is it papillary?

• Inflammatory• Metaplastic• Neoplastic

Is it Invasive?

• Scarring• Involvement of Von Brunn’s nests• Inverted growth pattern

What is the stage?

• Diathermy artefact – stage pTx• Muscularis mucosae Vs Muscularis propria• Fat invasion• Muscularis propria invasion• Invasion into the prostate

Urothelial Ca/TCC

• Grading• Differentiation • A few interesting subtypes, micropapillary, nested• Immunohistochemistry, cyt 7, cyt 20, Gata3, 34BE12

The END

• Any questions?