Updated February 2008

Clinico-pathologic Considerations

Transurethral Resection (TUR)

The pathology report should include the following information:

1. Presence or absence of tumour
2. Growth pattern, papillary or flat
3. Tumour grade: low grade or high grade (note i, ii)
4. Invasion: lamina propria, submucosal, muscularis propria (note iii, iv, v)
5. Invasion of lymphatics, vascular or perineural spaces
6. Extension in to prostate, either along ducts or as a result of prostatic stromal infiltration
7. Presence or absence of urothelial carcinoma in-situ

Notes:

1. May be further classified as grade I, II, III
2. A mix of tumour grades may occur. The highest grade is the reported tumour grade
3. Submucosal indicates beyond the muscularis mucosa. It may be impossible to distinguish between muscularis propria and hypertrophic muscularis mucosa
4. Because submucosa may contain adipose tissue which may intermingle with muscularis propria, interpretation of perivesical soft tissue extension in TUR specimens may be difficult
5. If muscularis propria is identified, the depth of muscle invasion cannot generally be reliably determined in TUR specimens

Radical Cystectomy

Radical cystectomy specimens should be marked at all excision margins. Margins should be sampled generously. Obvious tumour should be sampled. Random sections of apparently normal mucosa should be sampled.

The pathology report should include the following information:

1. Presence or absence of tumour
2. Tumour grade: Low grade or High grade (may sub classify as grade I-III)
3. Number, location and size of tumours
4. Depth of invasion: lamina propria, submucosa, inner vs. outer muscularis propria involvement, extravesical extension
5. Involvement of ureters, urethra, prostate or seminal vesicles, uterus, vagina, pelvic wall, abdominal wall
6. Surgical margins: perivesical soft tissue, vesical serosal surface, ureteric, urethral
7. Invasion of lymphatics, vascular or perineural spaces
8. Lymph nodes: number positive, largest metastasis, extranodal extension with extent
9. High grade flat carcinoma in-situ (present/absent)
10. pTNM tumour stage