| • Low power view showing several papillary fronds of a low grade transtional cell carcinoma. • The papillae show central fibrovascular core lined by transitional type epithelium. • Two papillae in the upper field are cut in cross-section and the papilla in the lower field is cut longitudinally. |
| Transitional Cell Carcinoma |
| Etiology |
•Risk factors include exposure to aromatic amines, cigarette smoking, recurrent nephrolithiasis and prolonged treatment with certain chemotherapeutic agents such as cyclophosphamide. •Bladders infested with Schistosoma haematobium are at increased risk for developing squamous cell carcinomas. |
| Pathogenesis |
| Continuous exposure to carcinogens/irritants may lead to accumulation of genetic mutations that are oncogenic. |
| Epidemiology |
•Patients with transitional cell carcinomas of the bladder are usually over 40 years of age. •Male:female ratio is approximately 3:1. |
| Clinical |
•Early manifestation of transitional cell carcinoma is painless hematuria. •Other urinary symptoms include dysuria, urinary frequency and urgency. •Ureteral obstruction, pelvic pain, and symptoms of metastatic lesions are rarely seen at presentation. |
| General Gross Description |
•Transitional cell carcinomas of the bladder have varying gross appearances. •Many are papillary and show exophytic growth above the mucosal level with tumor projecting into the bladder lumen. •Some transitional cell carcinomas are flat and may be ulcerating. •Both types can be invasive into the muscular wall of the bladder. |
| General Micro Description |
•Many transitional cell carcinomas of the bladder have a papillary growth pattern. •The papillae show a central fibrovascular core and are lined by transitional epithelium •The grade of the carcinoma is based primarily on the cytologic features of the epithelium •Grade I carcinomas closely resemble normal urothelium; usually not more than seven cell layers thick; bland or minimally atypical nuclei and rare mitosis. •Grade II carcinomas usually show thicker epithelium, i.e., more than 10 cell layers;a moderate degree of nuclear variability in size and chromasia. •Grade III carcinomas show marked nuclear pleomorphism, readily recognizable mitotic figures; loss of nuclear polarity; and usually show loss of cohesiveness of the epithelial cells. •Invasion into the lamina propria, muscularis, and lymphatic vessels are important prognostic features. |
| Reference |
• Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 998-1002.
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