Hi Dr Shah - I'm an Anatomical Path Registrar in my first year of training and I just wanted to thank you for your excellent lectures - they have helped me develop my knowledge of genitourinary pathology so much. You are an incredibly gifted teacher.
Thank you sir for the excellent presentation. Can low grade urothelial carcinomas be lamina propria invasive ? Should one be very cautious signing this out as its rare?
That is a great question! In my opinion, low-grade and invasion are oxymoron. I have virtually never signed out invasive low-grade urothelial carcinoma. there are case series, though suggesting such association. Regardless, once the urothelial carcinoma is invades, the grade does not matter.
Excellent presentation. Thank you for posting. I hope you don’t mind me asking a question. TURBT was done for bladder tumor in 62 year old man and on microscopic examination, there are prominent polyploid projections (no true papillae) with marked acute inflammation and exuberant eosinophils in mucosa, submucosa and muscularis propria (no necrosis in the latter). Is eosinophilic cystitis (EC) the correct diagnosis? EC is rare but we recently encountered 3 cases with similar histology making us question this diagnosis. Thank you very much.
Great and difficult question. There are no well-defined objective criteria for eosinophilic cystitis. The diagnosis depends on both combined histopathology and clinical . the presence of exuberant eosinophils that you describe is likely related to that diagnosis. Overall, I would descriptively mention this finding in report and ask them to correlate clinically. Hope this comment is helpful to you.
Differentiation of PUNLMP from Low grade depends on subtle features. PUNLMP is typically characterized by hyperplastic papillae with very minimal cytological and architectural disorder. We have to admit that this distinction is somewhat subjective. I am usually conservative and make this diagnosis in young age patients and meeting strict histological criteria. When you see cells not oriented in a very uniform pattern, that would indicate loss of polarity. Typically characterized by a nuclear crowding and overlap
Great question, Akshay! Keep in mind that dysplasia and CIS are essentially spectrum of lesions. The only way you differentiate between two is based on degree of architectural and cytological atypia. I certainly agree that dysplasia can also potentially exhibit angiogenesis
In paradoxical maturation the invading cells acquire more cytoplasm than surface components. Essentially the invading front has different cytological look than non-invasive front. Hope this is clear to you
