Clinical Pathology of the Urinary Bladder

A pathologic report for transurethral resection of bladder tumor (TURBT) specimens should include the following information: layers of bladder wall represented, adequacy of material for determining T category of pTNM stage, surface denuded or ulcerated, rough tumor size, tumor configuration (papillary, flat, solid/nodular, invasive, ulcerated, undetermined), histologic type [conventional, urothelial carcinoma with/without squamous differentiation, squamous cell carcinoma, adenocarcinoma (classical or variant), small cell carcinoma, undifferentiated, mixed cell type, undetermined], histologic grade (based on tumor type), microscopic extent of tumor/invasion/pathologic staging (noninvasive flat carcinoma in situ, invasive carcinoma involving lamina propria, muscularis propria; the latter present, absent, or indeterminate), lymphovascular invasion (present, not identified, indeterminate; should be assessed away from the main tumor and only if unequivocal; often is overdiagnosed), extension in prostatic chips sampled by TURBT [involvement of prostatic urethra, prostatic acini, and ducts (by carcinoma in situ) or prostatic stroma (by invasive carcinoma)], associated epithelial lesions [urothelial papilloma (classic or inverted type), papillary urothelial neoplasm of low malignant potential, other], and additional findings (carcinoma in situ, dysplasia, metaplasia, hyperplasia, inflammation, regenerative changes, treatment-related changes, or other). Some of these features may be difficult to identify on small biopsies. It is also recommended to include clinically relevant historical information.