Papillary urothelial carcinoma with distinct nuclear abnormalities, including presence of moderate to marked nuclear atypia, nucleoli, and pleomorphism

Age

Gender

Gross or microscopic hematuria is common

Urine cytology often shows carcinoma

Surgical approaches

Adjuvant therapy

High rate of progression to invasive disease

Exophytic papillary growth

Often have complex papillary architecture on low-power examination

Range of nuclear atypia is included in this category

Neoplastic cells are often crowded and overlapping

Nuclear contours typically irregular

Mitotic activity may be brisk, including on surface

Nucleoli may be prominent and often in a majority of cells

May be admixed with lower grade foci of carcinoma

Not required for diagnosis

Expression of CK20 and p53 is more frequent in high-grade carcinomas

Nuclear features are less atypical than in high-grade carcinoma

Mitoses are variable but not on surface

Cellular discohesion less common

Prominent umbrella cells are occasionally seen

Broad papillae with stromal edema

Do not have complex secondary or tertiary branching typical of papillary urothelial neoplasia

May have reactive urothelial atypia

Clinical impression is usually reactive

Papillae are lined by single cuboidal layer

May have other admixed morphologic patterns

Immunoreactivity for pax-2 and pax-8 is characteristic

Papillae lined by admixed prostatic secretory and urothelial cells

Express PSA and PAP in secretory cell component

May mimic endophytic growth in high-grade urothelial carcinoma

Thin trabecular architecture without solid expansile growth

Usually maintain prominent basal palisading in nests and trabeculae