Case 126
- Wangpan Shi
- May 30
- 1 min read
A 77-year-old male with a history of bladder lesion and here is the biopsy:
What's the diagnosis?
A: Carcinoma in situ
B: Urothelial dysplasia
C: High grade papillary urothelial carcinoma in situ
D: Reactive changes
E: Cystitis
Answer
The correct answer is A. This is a case of urothelial carcinoma in situ.
The key features in this case is pleomorphism, mitosis, high N:C ratio, and size.
Feature | Urothelial CIS | Reactive Atypia | Urothelial Dysplasia |
Nuclear size | Markedly enlarged | Mildly enlarged | Mild to moderate enlargement |
Nuclear pleomorphism | Prominent, pleomorphic | Mild or absent | Present but not overtly malignant |
Chromatin | Irregular, hyperchromatic | Fine, regular | Slightly irregular |
Nuclear contours | Irregular | Smooth | Mildly irregular |
Nuclear polarity | Lost | Preserved | Partially lost |
Crowding | Irregular, disorderly | Absent or minimal | Present but less severe than CIS |
Mitoses | May be frequent, atypical | Rare | May be present but not atypical |
Pagetoid spread / undermining | Present | Absent | Absent |
CK20 IHC | Full-thickness staining | Limited to umbrella cells | Patchy or increased |
p53 IHC | Diffuse strong or null | Wild-type/patchy | Variable |
CD44 IHC | Loss or basal only | Full-thickness | Basal or reduced |
Ki-67 | Elevated | Low | Intermediate |
Interpretation | High-grade intraepithelial carcinoma | Reactive process | Possible precursor lesion (borderline) |
Clinical implication | Requires definitive treatment | No treatment; monitor | Uncertain significance; monitor |
Case credit: UCSD Pathology
Author: Wangpan Shi, MD
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