Bladder cancer pathophysiology: Difference between revisions
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{{Bladder cancer}} | {{Bladder cancer}} | ||
{{SCC}} | {{CMG}}; {{AE}} {{F.K}} {{SC}} {{SCC}} | ||
==Overview== | ==Overview== | ||
[[Genes]] involved in the pathogenesis of bladder cancer include [[HRAS]], [[Retinoblastoma protein|Rb1]], [[PTEN]]/MMAC1, NAT2, and GSTM1. On gross pathology, flat lesions or papillary lesions are characteristic findings of non-invasive transitional cell carcinomas; a large infiltrative [[mass]] or a multifocal, flat to papillary lesion with delicate fronds are characteristic findings of invasive transitional cell carcinomas. On microscopic histopathological analysis, loss of [[cell]] polarity, [[nuclear]] crowding, and cytologic [[atypia]] are characteristic findings of flat lesion; fibrovascular stalks, umbrella cells, and [[eosinophilic]] [[cytoplasm]] are characteristic findings of [[papillary]] lesion; invasion beyond the [[basement membrane]] is the characteristic finding of invasive transitional cell carcinomas. | [[Genes]] involved in the pathogenesis of bladder cancer include [[HRAS]], [[Retinoblastoma protein|Rb1]], [[PTEN]]/MMAC1, NAT2, and GSTM1. On gross pathology, flat [[lesions]] or papillary lesions are characteristic findings of '''non-invasive''' transitional cell carcinomas; a large infiltrative [[mass]] or a multifocal, flat to papillary lesion with delicate fronds are characteristic findings of '''invasive''' transitional cell carcinomas. On microscopic histopathological analysis, loss of [[cell]] polarity, [[nuclear]] crowding, and cytologic [[atypia]] are characteristic findings of flat lesion; fibrovascular stalks, umbrella cells, and [[eosinophilic]] [[cytoplasm]] are characteristic findings of [[papillary]] lesion; invasion beyond the [[basement membrane]] is the characteristic finding of invasive transitional cell carcinomas. | ||
==Pathogenesis== | ==Pathogenesis== | ||
* Under normal conditions, the [[bladder]], the lower part of the [[kidneys]], the [[ureters]], and the proximal [[urethra]] are lined with a specialized [[mucous]] membrane referred to as [[transitional epithelium]] (also called [[urothelium]]). | * Under normal conditions, the [[bladder]], the lower part of the [[kidneys]], the [[ureters]], and the proximal [[urethra]] are lined with a specialized [[mucous]] membrane referred to as [[transitional epithelium]] (also called [[urothelium]]).<ref>Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/bladder-cancer/urothelial-carcinoma/?region=ab Accessed on October, 1 2015 </ref> | ||
* Most cancers that form in the bladder, the lower part of the [[kidneys]], the ureters, and the proximal urethra are transitional cell carcinomas (also called urothelial carcinomas) that derive from transitional epithelium. | * Most cancers that form in the bladder, the lower part of the [[kidneys]], the ureters, and the proximal urethra are transitional cell carcinomas (also called urothelial carcinomas) that derive from transitional epithelium. | ||
* Urothelial carcinomas may be non-invasive or invasive. | * Urothelial carcinomas may be non-invasive or invasive. | ||
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==Genetics== | ==Genetics== | ||
Genetic mutations:<ref name=”cancergov”>National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/types/bladder/hp/bladder-treatment-pdq#link/_359_toc </ref> | * Genetic mutations involved in the pathogenesis of bladder cancer include:<ref name=”cancergov”>National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/types/bladder/hp/bladder-treatment-pdq#link/_359_toc Accessed on October, 1 2015 </ref> | ||
* [[HRAS]] mutation | :* [[HRAS]] mutation | ||
* [[Retinoblastoma protein|Rb1]] mutation | :* [[Retinoblastoma protein|Rb1]] mutation | ||
* [[PTEN]]/MMAC1 mutation | :* [[PTEN]]/MMAC1 mutation | ||
* NAT2 slow acetylator phenotype | :* NAT2 slow acetylator phenotype | ||
* GSTM1 null phenotype | :* GSTM1 null phenotype | ||
==Gross Pathology== | ==Gross Pathology== | ||
* Non-invasive urothelial carcinoma<ref name="pmid10649257">{{cite journal| author=Cheng L, Cheville JC, Neumann RM, Bostwick DG| title=Flat intraepithelial lesions of the urinary bladder. | journal=Cancer | year= 2000 | volume= 88 | issue= 3 | pages= 625-31 | pmid=10649257 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10649257 }} </ref><ref name="pmid10199474">{{cite journal| author=Cheng L, Cheville JC, Neumann RM, Bostwick DG| title=Natural history of urothelial dysplasia of the bladder. | journal=Am J Surg Pathol | year= 1999 | volume= 23 | issue= 4 | pages= 443-7 | pmid=10199474 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10199474 }} </ref> | * Non-invasive urothelial carcinoma<ref name="pmid10649257">{{cite journal| author=Cheng L, Cheville JC, Neumann RM, Bostwick DG| title=Flat intraepithelial lesions of the urinary bladder. | journal=Cancer | year= 2000 | volume= 88 | issue= 3 | pages= 625-31 | pmid=10649257 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10649257 }} </ref><ref name="pmid10199474">{{cite journal| author=Cheng L, Cheville JC, Neumann RM, Bostwick DG| title=Natural history of urothelial dysplasia of the bladder. | journal=Am J Surg Pathol | year= 1999 | volume= 23 | issue= 4 | pages= 443-7 | pmid=10199474 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10199474 }} </ref> | ||
:* On gross pathology, flat lesions or papillary lesions are characteristic findings of non-invasive urothelial carcinoma. | :* On gross pathology, flat [[lesions]] or papillary lesions are characteristic findings of non-invasive urothelial carcinoma. | ||
* Invasive urothelial carcinoma<ref name="pmid21360040">{{cite journal| author=Pons F, Orsola A, Morote J, Bellmunt J| title=Variant forms of bladder cancer: basic considerations on treatment approaches. | journal=Curr Oncol Rep | year= 2011 | volume= 13 | issue= 3 | pages= 216-21 | pmid=21360040 | doi=10.1007/s11912-011-0161-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21360040 }} </ref> | * Invasive urothelial carcinoma<ref name="pmid21360040">{{cite journal| author=Pons F, Orsola A, Morote J, Bellmunt J| title=Variant forms of bladder cancer: basic considerations on treatment approaches. | journal=Curr Oncol Rep | year= 2011 | volume= 13 | issue= 3 | pages= 216-21 | pmid=21360040 | doi=10.1007/s11912-011-0161-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21360040 }} </ref> | ||
:* On gross pathology, a large infiltrative mass or a multifocal, flat to papillary lesion with delicate fronds are characteristic findings of invasive urothelial carcinoma. | :* On gross pathology, a large infiltrative [[mass]] or a multifocal, flat to papillary lesion with delicate fronds are characteristic findings of invasive urothelial carcinoma. | ||
==Microscopic Pathology== | ==Microscopic Pathology== | ||
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* Invasive urothelial carcinoma | * Invasive urothelial carcinoma | ||
:* On microscopic histopathological analysis, invasion beyond the [[basement membrane]] is the characteristic finding.<ref name="pmid21360040">{{cite journal| author=Pons F, Orsola A, Morote J, Bellmunt J| title=Variant forms of bladder cancer: basic considerations on treatment approaches. | journal=Curr Oncol Rep | year= 2011 | volume= 13 | issue= 3 | pages= 216-21 | pmid=21360040 | doi=10.1007/s11912-011-0161-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21360040 }} </ref> | :* On microscopic histopathological analysis, invasion beyond the [[basement membrane]] is the characteristic finding.<ref name="pmid21360040">{{cite journal| author=Pons F, Orsola A, Morote J, Bellmunt J| title=Variant forms of bladder cancer: basic considerations on treatment approaches. | journal=Curr Oncol Rep | year= 2011 | volume= 13 | issue= 3 | pages= 216-21 | pmid=21360040 | doi=10.1007/s11912-011-0161-4 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21360040 }} </ref> | ||
[[File:Bladder cancer.jpg|400px|thumb|left|Image showing muscle invasive urothelial carcinoma [https://librepathology.org/wiki/File:Muscle_invasive_urothelial_carcinoma_--_intermed_mag.jpg]]] | |||
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==References== | ==References== | ||
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[[Category:Types of cancer]] | [[Category:Types of cancer]] | ||
[[Category:Urology]] | [[Category:Urology]] | ||
[[Category:Up-To-Date]] | |||
[[Category:Oncology]] | |||
[[Category:Medicine]] | |||
[[Category:Nephrology]] | |||
[[Category:Surgery]] | |||
Latest revision as of 22:49, 17 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [3] Shanshan Cen, M.D. [4] Steven C. Campbell, M.D., Ph.D.
Overview
Genes involved in the pathogenesis of bladder cancer include HRAS, Rb1, PTEN/MMAC1, NAT2, and GSTM1. On gross pathology, flat lesions or papillary lesions are characteristic findings of non-invasive transitional cell carcinomas; a large infiltrative mass or a multifocal, flat to papillary lesion with delicate fronds are characteristic findings of invasive transitional cell carcinomas. On microscopic histopathological analysis, loss of cell polarity, nuclear crowding, and cytologic atypia are characteristic findings of flat lesion; fibrovascular stalks, umbrella cells, and eosinophilic cytoplasm are characteristic findings of papillary lesion; invasion beyond the basement membrane is the characteristic finding of invasive transitional cell carcinomas.
Pathogenesis
- Under normal conditions, the bladder, the lower part of the kidneys, the ureters, and the proximal urethra are lined with a specialized mucous membrane referred to as transitional epithelium (also called urothelium).[1]
- Most cancers that form in the bladder, the lower part of the kidneys, the ureters, and the proximal urethra are transitional cell carcinomas (also called urothelial carcinomas) that derive from transitional epithelium.
- Urothelial carcinomas may be non-invasive or invasive.
- Urothelial carcinomas with mixed epithelial features are invasive tumors that have different types of cells mixed with the cancer cells.
Genetics
- Genetic mutations involved in the pathogenesis of bladder cancer include:[2]
Gross Pathology
- On gross pathology, flat lesions or papillary lesions are characteristic findings of non-invasive urothelial carcinoma.
- Invasive urothelial carcinoma[5]
- On gross pathology, a large infiltrative mass or a multifocal, flat to papillary lesion with delicate fronds are characteristic findings of invasive urothelial carcinoma.
Microscopic Pathology
- Flat lesions
- Papillary lesions
- On microscopic histopathological analysis, fibrovascular stalks, umbrella cells, and eosinophilic cytoplasm are characteristic findings.
- Invasive urothelial carcinoma
- On microscopic histopathological analysis, invasion beyond the basement membrane is the characteristic finding.[5]
![[1]](https://librepathology.org/wiki/File:Muscle_invasive_urothelial_carcinoma_--_intermed_mag.jpg){kind=link}
References
- ↑ Bladder Cancer. Canadian Cancer Society 2015. http://www.cancer.ca/en/cancer-information/cancer-type/bladder/bladder-cancer/urothelial-carcinoma/?region=ab Accessed on October, 1 2015
- ↑ National Cancer Institute. Physician Data Query Database 2015. http://www.cancer.gov/types/bladder/hp/bladder-treatment-pdq#link/_359_toc Accessed on October, 1 2015
- ↑ 3.0 3.1 Cheng L, Cheville JC, Neumann RM, Bostwick DG (2000). "Flat intraepithelial lesions of the urinary bladder". Cancer. 88 (3): 625–31. PMID 10649257.
- ↑ Cheng L, Cheville JC, Neumann RM, Bostwick DG (1999). "Natural history of urothelial dysplasia of the bladder". Am J Surg Pathol. 23 (4): 443–7. PMID 10199474.
- ↑ 5.0 5.1 Pons F, Orsola A, Morote J, Bellmunt J (2011). "Variant forms of bladder cancer: basic considerations on treatment approaches". Curr Oncol Rep. 13 (3): 216–21. doi:10.1007/s11912-011-0161-4. PMID 21360040.
- ↑ McKenney JK, Amin MB, Young RH (2003). "Urothelial (transitional cell) papilloma of the urinary bladder: a clinicopathologic study of 26 cases". Mod Pathol. 16 (7): 623–9. doi:10.1097/01.MP.0000073973.74228.1E. PMID 12861056.
- ↑ Picozzi S, Casellato S, Bozzini G, Ratti D, Macchi A, Rubino B; et al. (2013). "Inverted papilloma of the bladder: a review and an analysis of the recent literature of 365 patients". Urol Oncol. 31 (8): 1584–90. doi:10.1016/j.urolonc.2012.03.009. PMID 22520573.