Clinical Pathology of the Urinary Bladder

  • George Agrogiannis
  • Christos Alamanis
  • Eleni A. Karatrasoglou
  • Georgios Kousournas
  • Andreas C. Lazaris
  • Vasileios Spapis
  • Georgia-Eleni Thomopoulou
  • Dionysia N. Zouki


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.

With regard to cystectomy (total/partial), cystoprostatectomy, and pelvic exenteration specimens, in addition to the above data, the following should be included: specimen type/procedure; tumor site and multifocality; exact tumor size; pTNM stage; surgical margin status (specify margins involved by invasive carcinoma or in situ carcinoma; if uninvolved by invasive carcinoma, specify distance from invasive carcinoma to margin); presence of tumor at margins of the urethra, ureter, paravesicular soft tissue, or pelvic soft tissue; and involvement of adjacent structures, perivesical fat, ureter (specify laterality), urethra, vagina, uterus and adnexae, pelvic sidewall (specify laterality), prostate, seminal vesicle (specify laterality), rectum, or others.


  1. Babjuk M, Böhle A, Burger M et al (2017a) EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update 2016. Eur Urol 71(3):447–461CrossRefPubMedGoogle Scholar
  2. Babjuk M, Burger M, Compérat E, et al (2017b) Non-muscle-invasive bladder cancer. In: European Association of Urology Guidelines. European Association of Urology. Available via Accessed 05 July 2017
  3. Balar AV, Galsky MD, Rosenberg JE et al (2017) Atezolizumab as first-line treatment in cisplatin-ineligible patients with locally advanced and metastatic urothelial carcinoma: a single-arm, multicentre, phase 2 trial. Lancet 389(10064):67–76CrossRefGoogle Scholar
  4. Bamias A, Aravantinos G, Deliveliotis C et al (2004) Docetaxel and cisplatin with granulocyte colony-stimulating factor (G-CSF) versus MVAC with G-CSF in advanced urothelial carcinoma: a multicenter, randomized, phase III study from the Hellenic Cooperative Oncology Group. J Clin Oncol 22:220–228CrossRefPubMedGoogle Scholar
  5. Bellmunt J, Théodore C, Demkov T et al (2009) Phase III trial of vinflunine plus best supportive care compared with best supportive care alone after a platinum containing regimen in patients with advanced transitional cell carcinoma of the urothelial tract. J Clin Oncol 27:4454–4461CrossRefPubMedGoogle Scholar
  6. Bellmunt J, von der Maase H, Mead GM et al (2012) Randomized phase III study comparing paclitaxel/cisplatin/gemcitabine and gemcitabine/cisplatin in patients with locally advanced or metastatic urothelial cancer without prior systemic therapy: EORTC Intergroup Study 30987. J Clin Oncol 30:1107–1113CrossRefPubMedPubMedCentralGoogle Scholar
  7. Brierley JD, Gospodarowicz MK, Wittekind C (eds) (2017) TNM classification of malignant tumors, 8th edn. UICC International Union Against Cancer, OxfordGoogle Scholar
  8. Burger M, Catto JW, Dalbagni G et al (2013) Epidemiology and risk factors of urothelial bladder cancer. Eur Urol 63(2):234–241CrossRefPubMedGoogle Scholar
  9. Cambier S, Sylvester R, Collette L et al (2016) EORTC Nomograms and risk groups for predicting recurrence, progression, and disease-specific and overall survival in non-muscle-invasive stage Ta-T1 urothelial bladder cancer patients treated with 1-3 years of maintenance bacillus Calmette-Guérin. Eur Urol 69(1):60–69CrossRefPubMedGoogle Scholar
  10. Cheng L, Cheville JC, Neumann RM et al (1999) Natural history of urothelial dysplasia of the bladder. Am J Surg Pathol 23(4):443–447CrossRefPubMedGoogle Scholar
  11. Cheng L, Montironi R, Davidson DD et al (2009) Staging and reporting of urothelial carcinoma of the urinary bladder. Mod Pathol 22:S70–S95CrossRefPubMedGoogle Scholar
  12. De Santis M, Bellmunt J, Mead G et al (2012) Randomized phase II/III trial assessing gemcitabine/carboplatin and methotrexate/carboplatin/vinblastine in patients with advanced urothelial cancer who are unfit for cisplatin-based chemotherapy: EORTC study 30986. J Clin Oncol 30:191–199CrossRefPubMedGoogle Scholar
  13. Dotan ZA, Tal R, Golijanin D et al (2006) Adult genitourinary sarcoma: the 25-year Memorial Sloan-Kettering experience. J Urol 176(5):2033–2038. discussion 2038–2039CrossRefPubMedGoogle Scholar
  14. Epstein JI, Amin MB, Reuter VR et al (1998) The World Health Organization/ International Society of Urological Pathology consensus classification of urothelial (transitional cell) neoplasms of the urinary bladder. Bladder Consensus Conference Committee. Am J Surg Pathol 22(12):1435–1448CrossRefPubMedGoogle Scholar
  15. Epstein JI (2005) The lower urinary tract and male genital system. In: Kumar V, Abbas AK, Fausto N (eds) Robbins and Cotran pathologic basis of disease, 7th edn. Elsevier Saunders, Philadelphia, pp 1030–1032CrossRefGoogle Scholar
  16. Epstein JI, Reuter VE, Amin MB (2010) Biopsy interpretation of the bladder. Lippincott, Williams & Wilkins, PhiladelphiaGoogle Scholar
  17. Fernandez-Gomez J, Madero R, Solsona E et al (2009) Predicting nonmuscle invasive bladder cancer recurrence and progression in patients treated with bacillus Calmette-Guerin: the CUETO scoring model. J Urol 182(5):2195–2203CrossRefPubMedGoogle Scholar
  18. Fletcher CDM, Bridge JA, Hogendoorn P, Mertens F (2013) WHO classification of tumours of soft tissue and bone, vol 5. IARC Press, Lyon, pp 83–84Google Scholar
  19. Franke EI, Misseri R, Cain MP et al (2011) Nephrogenic adenoma in the augmented bladder. J Urol 186(4 Suppl):1586–1589CrossRefPubMedGoogle Scholar
  20. Gabrilove JL, Jakubowski A, Scher H et al (1988) Effect of granulocyte colony-stimulating factor on neutropenia and associated morbidity due to chemotherapy for transitional-cell carcinoma of the urothelium. N Engl J Med 318:1414–1422CrossRefPubMedGoogle Scholar
  21. Galsky MD, Iasonos A, Mironov S et al (2007) Phase II trial of dose-dense doxorubicin plus gemcitabine followed by paclitaxel plus carboplatin in patients with advanced urothelial carcinoma and impaired renal function. Cancer 109:549–555CrossRefPubMedGoogle Scholar
  22. Hansel DE, Amin MB, Comperat E et al (2013) A contemporary update on pathology standards for bladder cancer: transurethral resection and radical cystectomy specimens. European Urol 63:321–332CrossRefGoogle Scholar
  23. Hoffman-Censits JH, Grivas P, Van Der Heijden MS et al (2016) IMvigor 210, a phase II trial of atezolizumab (MPDL3280A) in platinum-treated locally advanced or metastatic urothelial carcinoma (mUC). J Clin Oncol 34(Suppl 2S):Abstr 355CrossRefGoogle Scholar
  24. Jones S (2016) Non–muscle-invasive bladder cancer (Ta, T1, and CIS). In: Wein A, Kavoussi L, Partin A, Peters C (eds) Campbell-Walsh urology, 11th edn. Elsevier, Philadelphia, p 2205Google Scholar
  25. Konety B, Carol LP (2013) Urothelial carcinoma: cancers of the bladder, ureter, & renal pelvis. In: McAninch J, Lue T (eds) Smith and Tanagho’s general urology, 18th edn. McGraw-Hill, New York, pp 310–322Google Scholar
  26. Lamm D (1992) Carcinoma in situ. Urol Clin North Am 1992 19(3):499–508Google Scholar
  27. Lim M, Adsay NV, Grignon D et al (2009) Urothelial carcinoma with villoglandular differentiation: a study of 14 cases. Mod Pathol 22(10):1280–1286CrossRefPubMedGoogle Scholar
  28. Loehrer PJ, Einhorn LH, Elson PJ et al (1992) A randomized comparison of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol 10:1066–1073CrossRefPubMedGoogle Scholar
  29. Lopez-Beltran A, Pacelli A, Rothenberg HJ et al (1998) Carcinosarcoma and sarcomatoid carcinoma of the bladder: clinicopathological study of 41 cases. J Urol 159:1497–1503CrossRefPubMedGoogle Scholar
  30. Milowsky MI, Nanus DM, Maluf FC et al (2009) Final results of sequential doxorubicin plus gemcitabine and ifosfamide, paclitaxel, and cisplatin chemotherapy in patients with metastatic or locally advanced transitional cell carcinoma of the urothelium. J Clin Oncol 27:4062–4067CrossRefPubMedPubMedCentralGoogle Scholar
  31. Nieder AM, Porter MP, Soloway MS (2008) Radiation therapy for prostate cancer increases subsequent risk of bladder and rectal cancer: a population based cohort study. J Urol 180(5):2005–2009CrossRefPubMedGoogle Scholar
  32. Ozaki K, Kitagawa K, Gabata T et al (2014) A case of polypoid and papillary cystitis mimicking an advanced bladder carcinoma with invasion of perivesical fat. Urol Ann 6(1):72–74CrossRefPubMedPubMedCentralGoogle Scholar
  33. Ramirez D, Gupta A, Canter D et al (2016) Microscopic haematuria at time of diagnosis is associated with lower disease stage in patients with newly diagnosed bladder cancer. BJU Int 117(5):783–786CrossRefPubMedGoogle Scholar
  34. Rosai, Ackerman (2007) Urinary Tract. In: Damjanov I, Nola M, Rosai J (eds) Rosai and Ackerman’s surgical pathology review. Mosby Elsevier, Philadelphia, pp 237–238Google Scholar
  35. Rosser CJ, Slaton JW, Izawa JI et al (2003) Clinical presentation and outcome of high-grade urinary bladder leiomyosarcoma in adults. Urology 61(6):1151–1155CrossRefPubMedGoogle Scholar
  36. Sauter G, Amin AF, Busch C et al (2004) Noninvasive urothelial neoplasias: WHO classification of noninvasive papillary urothelial tumors. In: Eble J, Epstein J, Sesterhenn I (eds) World Health Organization classification of tumors: pathology and genetics of tumors of the urinary system and male genital organs. IARC Press, Lyon, p 110Google Scholar
  37. Semins MJ, Schoenberg MP (2007) A case of florid cystitis glandularis. Nat Clin Pract Urol 4(6):341–345CrossRefPubMedGoogle Scholar
  38. Sharma P, Retz M, Siefker-Radtke A et al (2017) Nivolumab in metastatic urothelial carcinoma after platinum therapy (Checkmate 275): a multicenter, single arm, phase II trial. Lancet Oncol 18(3):312–322CrossRefPubMedGoogle Scholar
  39. Smith AK, Hansel DE, Jones JS (2008) Role of cystitis cystica et glandularis and intestinal metaplasia in development of bladder carcinoma. Urology 71(5):915–918CrossRefPubMedGoogle Scholar
  40. Solsona E, Iborra I, Dumont R et al (2000) The 3-month clinical response to intravesical therapy as a predictive factor for progression in patients with high risk superficial bladder cancer. J Urol 164(3 Pt 1):685–689CrossRefPubMedGoogle Scholar
  41. Spiess PE, Kassouf W, Steinberg JR et al (2007) Review of the M.D. Anderson experience in the treatment of bladder sarcoma. Urol Oncol 25(1):38–45CrossRefPubMedGoogle Scholar
  42. Sternberg CN, de Mulder P, Schornagel JH et al (2006) Seven year update of an EORTC phase III trial of high-dose intensity M-VAC chemotherapy and G-CSF versus classic M-VAC in advanced urothelial tract tumours. Eur J Cancer 42:50–54CrossRefPubMedGoogle Scholar
  43. Strojan Flezar M (2010) Urine and bladder washing cytology for detection of urothelial carcinoma: standard test with new possibilities. Radiol Oncol 44(4):207–214Google Scholar
  44. Takenaka A, Yamada Y, Miyake H et al (2008) Clinical outcomes of bacillus Calmette-Guérin instillation therapy for carcinoma in situ of urinary bladder. Int J Urol 15(4):309–313CrossRefPubMedGoogle Scholar
  45. Têtu B (2009) Diagnosis of urothelial carcinoma from urine. Mod Pathol 22(Suppl 2):S53–S59CrossRefPubMedGoogle Scholar
  46. von der Maase H, Hansen SW, Roberts JT et al (2000) Gemcitabine and cisplatin versus methotrexate, vinblastine, doxorubicin, and cisplatin in advanced or metastatic bladder cancer: results of a large, randomized, multinational, multicenter, phase III study. J Clin Oncol 18:3068–3077CrossRefPubMedGoogle Scholar
  47. von der Maase H, Sengelov L, Roberts JT et al (2005) Long-term survival results of a randomized trial comparing gemcitabine plus cisplatin, with methotrexate, vinblastine, doxorubicin, plus cisplatin in patients with bladder cancer. J Clin Oncol 23:4602–4608CrossRefPubMedGoogle Scholar
  48. Witjes AJ, Lebret T, Compérat EM et al (2017a) Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 71(3):462–475CrossRefGoogle Scholar
  49. Witjes J, Compérat E, Cowan N, et al (2017b) Muscle-invasive and metastatic bladder cancer. In: European Association of Urology Guidelines. European Association of Urology. Available via Accessed 05 July 2017
  50. Wright JL, Lin DW, Porter MP (2008) The association between extent of lymphadenectomy and survival among patients with lymph node metastases undergoing radical cystectomy. Cancer 112(11):2401–2408CrossRefPubMedGoogle Scholar
  51. Yafi F, Brimo F, Steinberg J et al (2015) Prospective analysis of sensitivity and specificity of urinary cytology and other urinary biomarkers for bladder cancer. Urol Oncol 33(2):66.e25-31CrossRefPubMedGoogle Scholar
  52. Zelefsky MJ, Housman DM, Pei X et al (2012) Incidence of secondary cancer development after high-dose intensity-modulated radiotherapy and image-guided brachytherapy for the treatment of localized prostate cancer. Int J Radiat Oncol Biol Phys 83(3):953–959CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • George Agrogiannis
    • 1
  • Christos Alamanis
    • 1
  • Eleni A. Karatrasoglou
    • 1
  • Georgios Kousournas
    • 1
  • Andreas C. Lazaris
    • 1
  • Vasileios Spapis
    • 1
  • Georgia-Eleni Thomopoulou
    • 1
  • Dionysia N. Zouki
    • 1
  1. 1.AthensGreece

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