transurethral resection and biopsy

Reporting

- Gross findings - Cold-cup biopsy

• The estimated number of tissue fragments, aggregate dimensions
• The presence or absence of papillary growth
• All tissue fragments should be submitted

 Transurethral resection of the bladder (TURB)

• The estimated number of tissue fragments, aggregate dimensions
• Total weight of resected tissue fragments
• The proportion of tissue embedded, if not completely embedded

It is recommended that a minimum of 10 block cassettes be submitted for initial evaluation. If lamina propria invasion is identified, the entire specimen may be submitted to rule out muscularis propria invasion and to further assess the extent of invasion.

Microscopic findings

 General assessment

• Epithelial surface (intact, ulcerated, denuded)
• The presence or absence of muscularis propria (detrusor muscle)
• Comment on cautery artifact if it compromises evaluation

 Tumor assessment

• Anatomic location (if available)

 Histological diagnosis

• Specify invasive or noninvasive urothelial carcinoma

 Histologic grade
 Overall architecture (eg, papillary or flat)
 Pattern of invasion (nodular, trabecular, or infiltrative)
 The presence or absence of lymphovascular invasion
 Extent of invasion (specify if stromal invasion is present or not and the level of invasion)
 Invasion into lamina propria

• Extent and/or depth of invasion should be provided

 Reporting of muscularis mucosae invasion is optional, as muscularis mucosae is not uniformly present in the biopsy specimens

• Invasion into muscularis propria (detrusor muscle)
• T2 substaging (pT2a versus T2b) cannot be performed on biopsy specimens
• Statements of tumor stage should provided (eg, at least T1, or T2)
• Comment that accurate staging may require complete resection of the tumor
• T2 substaging (pT2a versus T2b) cannot be performed on biopsy specimens
• Fat invasion in biopsy is not necessarily indicative of extravesical invasion (pT3), as fat is present throughout the bladder wall
• Findings in the adjacent mucosa

 The presence or absence of dysplasia, carcinoma in situ
 Other findings: intestinal metaplasis, cystitis glandularis, keratinizing squamous metaplasia etc.

Links

 http://www.nature.com/modpathol/journal/v22/n2s/fig_tab/modpathol20091t3.html

 Staging and reporting of urothelial carcinoma of the urinary bladder. Liang Cheng et al. 2009 http://www.nature.com/modpathol/journal/v22/n2s/full/modpathol20091a.html