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Adenomyosis

Def.:

• Presence of histologically benign endometrial tissue within the myometrium along with myometrial hypertrophy.

• The uterus is enlarged.

• cut section: diffuse thickness of uterine wall with areas of haemorrhages.

Adenomyosis

• Normal, benign endometrial islands composed of glands & stroma deep within the hypertrophied muscular layer

Adenomyosis

• Normal, benign endometrial islands composed of glands & stroma deep within the hypertrophied muscular layer

ENDOMETRIOSIS

Def.:

The presence of endometrial glands

and stroma in abnormal locations

outside the uterus.

Typically, the foci of endometriosis

appear as blue or brownish-black.

foci of

endometrial glands and stroma, old

or new haemorrhages, haemosiderin

laden macrophages and surrounding

zone of inflammation and fibrosis.

ENDOMETRIOSIS

Def.:

The presence of endometrial glands

and stroma in abnormal locations

outside the uterus.

Typically, the foci of endometriosis

appear as blue or brownish-black.

foci of

endometrial glands and stroma, old

or new haemorrhages, haemosiderin

laden macrophages and surrounding

zone of inflammation and fibrosis.

Endometrial Adenocarcinoma

- Morphology:

○ Macro:

-Polypoid/Cauliflower-Like Growth + Distended Uterus ⁃

Areas of Haemorrhage, Necrosis & Infiltration

Endometrial adenocarcinoma

o Micro:

Adenocarcinoma of Endometrial

Glands:

Endometrioid (most common)

• Numerous, Small, Back-to-Back Glands

•Irregular & Dysplastic Cells

• Little Stroma

may be well-differentiated,

moderately-differentiated or poorly

differentiated

LEIOMYOMA/fibromyomas/ fibroids

The most common uterine tumours, of smooth muscle origin,

/A

occur within the myometrium (intramural or interstitia/, the serosa (subserosa/), or just underneath the endometrium (submucosa/)

often multiple, circumscribed, firm, nodular, grey-white masses of variable size.

characteristic whorled pattern.

LEIOMYOMA/fibromyomas/ fibroids

The most common uterine tumours, of smooth muscle origin,

/A

occur within the myometrium (intramural or interstitia/, the serosa (subserosa/), or just underneath the endometrium (submucosa/)

often multiple, circumscribed, firm, nodular, grey-white masses of variable size.

characteristic whorled pattern.

LEIOMYOMA/fibromyomas/ fibroids

The most common uterine tumours, of smooth muscle origin,

/A

occur within the myometrium (intramural or interstitia/, the serosa (subserosa/), or just underneath the endometrium (submucosa/)

often multiple, circumscribed, firm, nodular, grey-white masses of variable size.

characteristic whorled pattern.

Leiomyoma

• MORPHOLOGIC FEATURES ME

whorled bundles of

smooth muscle cells + connective tissue

The smooth muscle cells are uniform in size and shape with abundant cytoplasm and central oval nuclei.

& Mitosis is infrequent

Serous Tumors: Benign Serous Cystadenoma

Gross:

•Unilocular or multilocular cysts, often with papillary projections;

•malignant forms may have solid areas.

Microscopy:

•Papillary structures Lined by ciliated columnar epithelium; Psammoma bodies seen in malignant forms.

Serous Tumors: Benign Serous Cystadenoma

Gross:

•Unilocular or multilocular cysts, often with papillary projections;

•malignant forms may have solid areas.

Microscopy:

•Papillary structures Lined by ciliated columnar epithelium; Psammoma bodies seen in malignant forms.

Serous Tumors: Benign Serous Cystadenoma

Gross:

•Unilocular or multilocular cysts, often with papillary projections;

•malignant forms may have solid areas.

Microscopy:

•Papillary structures Lined by ciliated columnar epithelium; Psammoma bodies seen in malignant forms.

Serous Tumors: Benign Serous Cystadenoma

Gross:

•Unilocular or multilocular cysts, often with papillary projections;

•malignant forms may have solid areas.

Microscopy:

•Papillary structures Lined by ciliated columnar epithelium; Psammoma bodies seen in malignant forms.

Serous Tumors: Bordeline Serous Tumor

Gross:

•Unilocular or multilocular cysts, often with papillary projections;

•malignant forms may have solid areas.

Microscopy:

•Papillary structures Lined by ciliated columnar epithelium; Psammoma bodies seen in malignant forms.

Serous Tumors: Bordeline Serous Tumor

Gross:

•Unilocular or multilocular cysts, often with papillary projections;

•malignant forms may have solid areas.

Microscopy:

•Papillary structures Lined by ciliated columnar epithelium; Psammoma bodies seen in malignant forms.

Serous Tumors: Bordeline Serous Tumor

Gross:

•Unilocular or multilocular cysts, often with papillary projections;

•malignant forms may have solid areas.

Microscopy

•Papillary structures Lined by ciliated columnar epithelium; Psammoma bodies seen in malignant forms.

Serous Tumors: Serous carcinoma

Gross:

•Unilocular or multilocular cysts, often with papillary projections;

•malignant forms may have solid areas.

Microscopy:

•Papillary structures Lined by ciliated columnar epithelium; Psammoma bodies seen in malignant forms.

Serous Tumors: Serous carcinoma

Gross:

•Unilocular or multilocular cysts, often with papillary projections;

•malignant forms may have solid areas.

Microscopy:

•Papillary structures Lined by ciliated columnar epithelium; Psammoma bodies seen in malignant forms.

•Mucinous Tumors:

Gross:

•Large, multilocular cysts

filled with thick, gelatinous

material; malignant forms

may show necrosis.

Microscopy:

•Glandular structures lined by

Lined by mucin-secreting

columnar epithelium;

•may be associated with

pseudomyxoma peritonei

•Mucinous Tumors:

Gross:

•Large, multilocular cysts

filled with thick, gelatinous

material; malignant forms

may show necrosis.

Microscopy:

•Glandular structures lined by

Lined by mucin-secreting

columnar epithelium;

•may be associated with

pseudomyxoma peritonei

•Clear Cell Carcinoma: Microscopy:

•Clear cells, •Hobnail cells

•Brenner Tumor

Gross:

sharply demarcated, solid, yellow

white cut surface

Microscopy:

•mature transitional

epithelium (urothelium) arranged in

sharply defined solid clusters,

nests and trabeculae of within a

dense fibromatous stroma

•Brenner Tumor

Gross:

sharply demarcated, solid, yellow

white cut surface

Microscopy:

•mature transitional

epithelium (urothelium) arranged in

sharply defined solid clusters,

nests and trabeculae of within a

dense fibromatous stroma

B. Germ Cell Tumors (15-20%)

Dysgerminoma

Gross:

solid mass. Grey white, homogenous

Microscopy:

monomorphic tumor ells arranged

in diffuse sheets, & separated

by delicate fibrous septae

contain lymphocytes (T cells), plasma

cells

B. Germ Cell Tumors (15-20%)

Dysgerminoma

Gross:

solid mass. Grey white, homogenous

Microscopy:

monomorphic tumor ells arranged

in diffuse sheets, & separated

by delicate fibrous septae

contain lymphocytes (T cells), plasma

cells

B. Germ Cell Tumors (15-20%)

Yolk Sac Tumor

Microscopy:

papillary structure is contained

within a cystic space lined by

flattened cells (Glomeruloid),

=Schiller-Duval body

a hallmark of yolk sac tumor

B. Germ Cell Tumors (15-20%)

Yolk Sac Tumor

Microscopy:

papillary structure is contained

within a cystic space lined by

flattened cells (Glomeruloid),

=Schiller-Duval body

a hallmark of yolk sac tumor

Mature Teratoma (Dermoid Cyst G/A

• unilocular cvst. lined by the skin

& filled with paste-like sebaceous secretions and desquamated keratin admixed with masses of hair

• Generallv. in one area of the cvst wall. solid prominence is seen (Rokitansky's protuberance) where tissue elements such as tooth, bone, cartilage and various other odd tissues are present.

Mature Teratoma (Dermoid Cyst G/A

• unilocular cvst. lined by the skin

& filled with paste-like sebaceous secretions and desquamated keratin admixed with masses of hair

• Generallv. in one area of the cvst wall. solid prominence is seen (Rokitansky's protuberance) where tissue elements such as tooth, bone, cartilage and various other odd tissues are present.

. Mature Teratoma (Dermoid Cyst)

Multiple Mature

ME:

Tissues in one tumour & Encapsulated

Ectodermal derivatives are most prominent: lining of the cyst wall is stratified squamous epithelium and its adnexal structures such as sebaceous glands, sweat glands and hair follicles.

• Tissues of mesodermal and endodermal origin are also commonly present.

. Mature Teratoma (Dermoid Cyst)

Multiple Mature

ME:

Tissues in one tumour & Encapsulated

Ectodermal derivatives are most prominent: lining of the cyst wall is stratified squamous epithelium and its adnexal structures such as sebaceous glands, sweat glands and hair follicles.

• Tissues of mesodermal and endodermal origin are also commonly present.

Granulosa Cell Tumor

• all ages.

• secrete oestrogen.

GIA

• small, solid, partly cystic and usually unilateral tumour.

• Cut section of solid areas is yellowish-brown M/E

• granulosa cells are arranged in micro- and macrofollicular, trabecular, bands and diffuse sheets.

• rosettelike structures called:

Call-Exner bodies: central rounded pink mass surrounded by a circular row of granulosa cells having grooved nuclei with coffee-bean appearance.

Granulosa Cell Tumor

• all ages.

• secrete oestrogen.

GIA

• small, solid, partly cystic and usually unilateral tumour.

• Cut section of solid areas is yellowish-brown M/E

• granulosa cells are arranged in micro- and macrofollicular, trabecular, bands and diffuse sheets.

• rosettelike structures called:

Call-Exner bodies: central rounded pink mass surrounded by a circular row of granulosa cells having grooved nuclei with coffee-bean appearance.

Granulosa Cell Tumor

• all ages.

• secrete oestrogen.

GIA

• small, solid, partly cystic and usually unilateral tumour.

• Cut section of solid areas is yellowish-brown M/E

• granulosa cells are arranged in micro- and macrofollicular, trabecular, bands and diffuse sheets.

• rosettelike structures called:

Call-Exner bodies: central rounded pink mass surrounded by a circular row of granulosa cells having grooved nuclei with coffee-bean appearance.

Krukenberg Tumor:

•Bilateral ovarian metastases by

transcoelomic spread from gastric, colon,

appendix and breast carcinoma;

GIA

• moderately large, rounded or kidney shaped,

firm, multinodular masses in both ovaries.

ME

• mucin-filled signet ring cells which may lie

singly or in clusters

Krukenberg Tumor:

•Bilateral ovarian metastases by

transcoelomic spread from gastric, colon,

appendix and breast carcinoma;

GIA

• moderately large, rounded or kidney shaped,

firm, multinodular masses in both ovaries.

ME

• mucin-filled signet ring cells which may lie

singly or in clusters

Fibrocystic changes

G/A

○ Grey-white Scar Tissue (Fibrosis) ○ Multiple Cystic Lesions.

FIBROCYSTIC CHANGE - Morphology:

M/E

o Non Proliferative: 1. Cyst formation

• lining flattened or atrophic.

• Frequently, there is apocrine metaplasia 2. Fibrosis surrounding the cysts and

variable degree of stromal lymphocytic infiltrate.

Fibroadenoma “breast mouse”

Capsulated, Firm,

Homogenous, Grey, Nodular/lobulated Tumour, Without Cysts.

Lobulated, circumscribed Without Cysts.

Fibroadenoma “Breast mouse”

Capsulated, Firm,

Homogenous, Grey, Nodular/lobulated Tumour, Without Cysts.

Lobulated, circumscribed Without Cysts.

Fibroadenoma “Breast Mouse”

Fibrous tissue comprises most of a fibroadenoma,.

The arrangements between fibrous overgrowth and ducts may produce two types of patterns in the same tumour

⁃ Intracanalicular pattern :stroma compresses the ducts ---slit-like clefts lined by ductal epithelium or

⁃ Pericanalicular pattern: encircling masses of fibrous stroma around the patent or dilated

ducts.

Fibroadenoma “breast mouse”

Fibrous tissue comprises most of a fibroadenoma,.

The arrangements between fibrous overgrowth and ducts may produce two types of patterns in the same tumour

⁃ Intracanalicular pattern :stroma compresses the ducts ---slit-like clefts lined by ductal epithelium or

⁃ Pericanalicular pattern: encircling masses of fibrous stroma around the patent or dilated

ducts.

Paget’s disease

Gross picture:

Nipple eczema or ulceration. Excoriation of the areola. There may or may not be a palpable mass.

Paget’s disease

Gross picture:

Nipple eczema or ulceration. Excoriation of the areola. There may or may not be a palpable mass.

Paget’s disease

Gross picture:

Nipple eczema or ulceration. Excoriation of the areola. There may or may not be a palpable mass.

• Microscopic picture:

• The basal layer of epidermis

is infiltrated by large

malignant cells with:

a) Clear cytoplasm. & Large

hyperchromatic nuclei

(Paget's cells).

•The underlying carcinoma

may be:

a) Intraductal.

b) Invasive carcinoma.

Nipple Retraction

Peau d’orange

Ulceration

Invasive Ductal carcinoma no special type

• Gross picture:

-Shape: non-capsulated, irregular and spiky.

-Consistency: hard.

-Size: variable usually >1 cm.

-Colour: Grayish white.

-Mobility: Early mobile but late fixed.

The cut surface:

• Greyish white,

• Concave (due to retraction of excessive

fibrosis)

• The tumor gives a gritty sensation during

cutting

Invasive ductal carcinoma no ductal type

• Gross picture:

-Shape: non-capsulated, irregular and spiky.

Consistency: hard.

-Size: variable usually >1 cm .

-Colour: Grayish white.

-Mobility: Early mobile but late fixed. The cut surface:

• Greyish white,

• Concave (due to retraction of excessive fibrosis)

• The tumor gives a gritty sensation during cutting.

Poorly circumscribed, firm to hard mass with irregular, infiltrative margins (crab-like).

Cut section is whitish and gritty. (arrow in the middle)

B. Invasive Breast Carcinoma

Invasive Ductal Carcinoma of No Special Type (|BC-NST)

-Diffuse sheets, well-defined nests, and cords of malignant ductal cells.

-Sheets are separated by productive dense stromal fibrosis (Desmoplastic reaction,

B. Invasive Breast Carcinoma

Invasive Ductal Carcinoma of No Special Type (|BC-NST)

-Diffuse sheets, well-defined nests, and cords of malignant ductal cells.

-Sheets are separated by productive dense stromal fibrosis (Desmoplastic reaction,

Invasive lobular carcinoma:

• The tumor cells are small to medium-sized regular, and uniform ,with little cytological abnormalities.

• They grow singly in the form of linear cords (Indian File fibrous stroma.

Invasive lobular carcinoma:

• The tumor cells are small to medium-sized regular, and uniform ,with little cytological abnormalities.

• They grow singly in the form of linear cords (Indian File fibrous stroma.

POLYCYSTIC KIDNEY DISEASE

Bilateral, large cystic kidney

o Some areas of Haemorrhage

o Some normal kidney tissue between cysts

- Cysts:

o = Bulging, filtrate-filled pouches of kidney.

o Caused by a Nephron not connecting to any collecting duct - (le: Filtrate has nowhere to go → Expands & Expands)

In AR (childhood type) all tubules are affected & in AD (Adult type, many tubules are affected)

POLYCYSTIC KIDNEY DISEASE

Bilateral, large cystic kidney

o Some areas of Haemorrhage

o Some normal kidney tissue between cysts

- Cysts:

o = Bulging, filtrate-filled pouches of kidney.

o Caused by a Nephron not connecting to any collecting duct - (le: Filtrate has nowhere to go → Expands & Expands)

In AR (childhood type) all tubules are affected & in AD (Adult type, many tubules are affected)

POLYCYSTIC KIDNEY DISEASE

Bilateral, large cystic kidney

o Some areas of Haemorrhage

o Some normal kidney tissue between cysts

- Cysts:

o = Bulging, filtrate-filled pouches of kidney.

o Caused by a Nephron not connecting to any collecting duct - (le: Filtrate has nowhere to go → Expands & Expands)

In AR (childhood type) all tubules are affected & in AD (Adult type, many tubules are affected)

Minimal Change disease

- Pathologic features: *Electron microscopy: fusion (effacement) of the foot processes of epithelial cells (Podocytes)

SGS - FOCAL SEGMENTAL

GLOMERULOSCLEROSIS:

⁃ Very Similar to Minimal Change Disease, but in young Adults

*Pathologic features:

Microscopic picture:

○

starts in the juxtamedullary glomeruli.

○ Affects parts (segmental) of some (focal)

glomeruli of nephron

○ Foot processes of podocytes damaged

○ hyalinosis (hyaline/ glassy view on histology, -> scar tissue (glomerulosclerosis

3- MGN- MEMBRANOUS GLOMERULONEPHRITIS:

- MGN = >50% of Adult Nephrotic Syndrome

*Pathologic features:

Microscopic picture:

diffuse hyaline thickening and formation of spikes

giving hair comb appearance of the basement membrane.

4- Membranoproliferative glomerulonephritis:

65% present as nephrotic & 35% mixed

nephrotic & nephritic

*Pathologic features:

Microscopic picture:

D Enlarged hypercellular lobulated glomeruli

due to mesangial proliferation.

2 Thickened capillary walls with double

contour / tram track appearance

Best demonstrated by silver or PAS stain

1- PSGN - POST-STREPTOCOCCAL GLOMERULONEPHRITIS:

THE Childhood cause of Nephritic Syndrome

Pathological features: icroscopic picture:

-Glomeruli: diffusely swollen and cellular (proliferation of endothelial cells + leucocytic nfiltration).

-Convoluted tubules : cloudy swelling and fatty hange of lining cells,.

-Collecting tubules: casts in their lumen (mainly lood casts).

-Interstitial tissue: edematous, hyperemic and shows leucocytic infiltration.

1- PSGN - POST-STREPTOCOCCAL GLOMERULONEPHRITIS:

THE Childhood cause of Nephritic Syndrome

Pathological features: icroscopic picture:

-Glomeruli: diffusely swollen and cellular (proliferation of endothelial cells + leucocytic nfiltration).

-Convoluted tubules : cloudy swelling and fatty hange of lining cells,.

-Collecting tubules: casts in their lumen (mainly lood casts).

-Interstitial tissue: edematous, hyperemic and shows leucocytic infiltration.

Immunofluorescence: Granular (hump-like) deposits

Rapidly progressive glomerulonephritis: (Crescentic glomerulonephritis)

• *Pathological features:

Microscopic picture:

1- Glomeruli: show crescent formation due to proliferation of the parietal layer of the Bowman's capsule.

2- compressed capillary tufts that become

replaced by fibrous tissue.

3-Thrombosis in the capillary loops and adhesions between the tuft and the capsule.

4-Focal tubular necrosis & interstitial inflammatory cellular infiltration. Tubular lumen contains red cells, hyaline and cellular casts.

Rapidly progressive glomerulonephritis: (Crescentic glomerulonephritis)

• *Pathological features:

Microscopic picture:

1- Glomeruli: show crescent formation due to proliferation of the parietal layer of the Bowman's capsule.

2- compressed capillary tufts that become

replaced by fibrous tissue.

3-Thrombosis in the capillary loops and adhesions between the tuft and the capsule.

4-Focal tubular necrosis & interstitial inflammatory cellular infiltration. Tubular lumen contains red cells, hyaline and cellular casts.

*Immunofluorescence: According to cause,

in Goodpasture's syndrome:

linear pattern deposits of antibodies along GBM

Chronic slowly progressive glomerulonephritis

[End stage Kidney]

*Pathological features:

Gross picture:

1. The kidneys are small in size

and firm.

2. The surface is finely granular,

and the capsule is adherent and

difficult to strip with decortication.

3. The cut surface shows that the

cortex is narrowed and not

demarcated from the medulla. The

peri pelvic fat is increased.

Chronic slowly progressive glomerulonephritis

[End stage Kidney]

*Pathological features:

Gross picture:

1. The kidneys are small in size

and firm.

2. The surface is finely granular,

and the capsule is adherent and

difficult to strip with decortication.

3. The cut surface shows that the

cortex is narrowed and not

demarcated from the medulla. The

peri pelvic fat is increased.

Chronic slowly progressive glomerulonephritis:

Microscopic picture:

1. Glomeruli : sclerosed.

2. Tubules:

contains hyaline and granular casts & are:

Some are atrophied & others show

compensatory hypertrophy, dilatation and

cyst formation

3. Interstitial fibrosis and infiltration by

chronic inflammatory cells.

4. Thick Medium sized and small arteries

Chronic Pyelonephritis

Tubular atrophy and dilation, with thyroidization (dilated tubules filled with eosinophilic material resembling thyroid colloid).

- Interstitium: Chronic inflammatory infiltrates & Fibrosis

Glomeruli may show ischemic changes due to scarring.

Hydronephrosis

Morphology:

1- Enlarged kidney

2- Urine stasis: infection and stone formation.

3- Pyonephrosis and pyelonephiritis: hematuria &pyuria.

4- Bilateral hydro ureter & hydronephrosis: ends by CRF.

5- Bladder wall trabeculation... diverticulosis in cases of Bladder neck or uretheral obstruction.

Angiomyolipoma (AML)

Gross Pathology

Well-circumscribed, non

encapsulated mass

Yellow-tan color due to abundant fat

content

Heterogeneous cut surface, with

areas of:

Yellow (adipose tissue)

Pink to tan (smooth muscle

component)

Red-brown (vascular component)

May show hemorrhagic areas

(spontaneous rupture and bleeding

in larger tumors >4 cm)

Angiomyolipoma (AML)

• Microscopic Pathology

The three characteristic components are:

1.Adipose Tissue

1. Mature adipocytes (variable quantity)

2. Can predominate in some cases (lipomatous

variant)

2.Smooth Muscle Cells

1. Spindle or epithelioid smooth muscle cells

arranged in bundles

2. May show nuclear atypia (not a sign of

malignancy in AML)

3.Thick-Walled Blood Vessels

1. Irregular, dysmorphic blood vessels with

thickened walls

2. Lack of elastic fibers, making vessels prone

to rupture and hemorrhage

Renal Oncocytoma

• Benign epithelial tumor

• Originates from intercalated cells of the collecting duct

• Gross Pathologic Features:

• Well-circumscribed, mahogany-brown mas • Central stellate scar (not always present

• No necrosis or hemorrhage

• Microscopic Pathologic Features:

• Large polygonal cells with abundant eosinophilic, granular cytoplasm (due to numerous mitochondria

• Round, uniform nuclei with prominent nucleoli

Renal Oncocytoma

• Benign epithelial tumor

• Originates from intercalated cells of the collecting duct

• Gross Pathologic Features:

• Well-circumscribed, mahogany-brown mas • Central stellate scar (not always present

• No necrosis or hemorrhage

• Microscopic Pathologic Features:

• Large polygonal cells with abundant eosinophilic, granular cytoplasm (due to numerous mitochondria

• Round, uniform nuclei with prominent nucleoli

Renal Cell Carcinoma

. Clear Cell Renal Cell Carcinoma (ccRCC) (Most common subtype: 70-80% of RCC cases

Origin: it arises from the epithelium of the convoluted tubules.

Incidence: usually common in males more than 40 years of age.

Gross Pathologic Features:

• Well-circumscribed, golden-yellow mass (due to lipid content

• Areas of hemorrhage, necrosis, and cystic degeneration (variegated cut surface

• Typically located in the upper pole of the kidney • Typically located in the upper pole of the kidney

1.Clear Cell Renal Cell Carcinoma (ccRCC)

• Microscopic Pathologic Features:

• Tumor cells Round to polygonal cells with clear cytoplasm & distinct cell membranes

• Nuclei varv from low-grade (small round nuclei) to high-grade (large, pleomorphic nuclei)

• Delicate, branching vasculature chicken-wire pattern

2. Chromophobe Renal Cell Carcinoma

• (5-7% of RCC cases)

• Gross Pathologic Features:

• Tan or pale, well-circumscribed mass with a central scar (15%)

• Usually lacks necrosis and hemorrhage

Chromophobe Renal Cell Carcinoma Microscopic Pathologic Features:

. Large polygonal cells with pale, eosinophilic cytoplasm and distinct cell borders (plant cell-like appearance)

. Perinuclear halos and coarse cytoplasmic granules

• Nuclei are irregular, often described as raisinoid

Chromophobe Renal Cell Carcinoma Microscopic Pathologic Features:

. Large polygonal cells with pale, eosinophilic cytoplasm and distinct cell borders (plant cell-like appearance)

. Perinuclear halos and coarse cytoplasmic granules

• Nuclei are irregular, often described as raisinoid

Wilms Tumor (Nephroblastoma)

• Gross Pathology

• Large, well-circumscribed mass that

can occupy the entire kidney

• Soft, gray-tan cut surface

• Areas of necrosis, hemorrhage, and

cystic degeneration are common

• Unilateral in most cases

& can be bilateral in syndromic cases

Urothelial Papilloma

• Benign tumor

. Gross Pathology:

• Small, exophytic lesion, usually <1 cm

. Located most commonly in the bladder

• Papillary, with a delicate fibrovascular core

• Microscopic Pathology:

• Orderly architecture with normal thickness of urothelium (3-7 layers)

No cytologic atypia

• Thin fibrovascular cores

Urothelial Papilloma

• Benign tumor

. Gross Pathology:

• Small, exophytic lesion, usually <1 cm

. Located most commonly in the bladder

• Papillary, with a delicate fibrovascular core

• Microscopic Pathology:

• Orderly architecture with normal thickness of urothelium (3-7 layers)

No cytologic atypia

• Thin fibrovascular cores

Urothelial Carcinoma in Situ (CIS)

•Flat, high-grade neoplasm confined to the

urothelium.

• Microscopic Pathology:

• High-grade cytologic atypia with disorganized

architecture

• Enlarged, hyperchromatic nuclei with prominent

nucleoli

• Frequent mitotic figures, including atypical forms

• Lack of maturation from basal to superficial layers

Exophytic Papillary Bladder Carcinoma

Gross Pathology:

• Multifocal exophytic Papillary masses with soft, friable appearance

Endophytic Infiltrative Bladder Carcinoma

Gross Pathology:

• Ulcerative mass infiltrating bladder hemorrhage

4. Low-Grade Papillary Urothelial Carcinoma

Microscopic Pathology:

• Papillary structures with very thin

fibrovascular core.

• Each papilla is covered by malignant

transitional epithelium (more than seven

layers) with:

• mild cvtologic atvpia

• Preserved polarity and architecture

• Nuclei are slightly enlarged, with irregular

contours but without prominent nucleoli

.

Low mitotic activity

4. Low-Grade Papillary Urothelial Carcinoma

Microscopic Pathology:

• Papillary structures with very thin

fibrovascular core.

• Each papilla is covered by malignant

transitional epithelium (more than seven

layers) with:

• mild cvtologic atvpia

• Preserved polarity and architecture

• Nuclei are slightly enlarged, with irregular

contours but without prominent nucleoli

.

Low mitotic activity

5. High-Grade Urothelial Carcinoma

Microscopic Pathology:

Marked nuclear atypia, loss of polarity, and frequent mitoses

• High nuclear-to-cvtoplasmic ratio

• Irregular, hyperchromatic nuclei with prominent nucleoli

• Invasive component often present, infiltrating the lamina propria or muscularis propria

• Variants: Micropapillary, sarcomatoid, plasmacytoid, nested

5. High-Grade Urothelial Carcinoma

Microscopic Pathology:

Marked nuclear atypia, loss of polarity, and frequent mitoses

• High nuclear-to-cvtoplasmic ratio

• Irregular, hyperchromatic nuclei with prominent nucleoli

• Invasive component often present, infiltrating the lamina propria or muscularis propria

• Variants: Micropapillary, sarcomatoid, plasmacytoid, nested

High-Grade Urothelial Carcinoma

• Microscopic Pathology:

Invasive component

Lamina Propria