Primary noninvasive urothelial neoplasms

Author: Rugvedita Parakh, M.D. (see Authors page)

Revised: 21 March 2016, last major update February 2013

Copyright: (c) 2003-2016,, Inc.

PubMed Search: Bladder neoplasms[title]
Table of Contents
Definition / General
Cite this page: Primary noninvasive urothelial neoplasms. website. Accessed October 28th, 2016.
Definition / General

  • See also papilloma
  • Increased number of urothelial cells with minimal atypia and a small number of red blood cells

Papillary urothelial neoplasm of low malignant potential (PUNLMP)
  • See also papillary neoplasm of low malignant potential
  • These lesions are cytologically indistinguishable from low grade urothelial carcinomas
  • Diagnosis of PUNLMP based only on cytology is not a reproducible diagnosis

Low grade papillary urothelial carcinoma
  • See also low grade papillary
  • Low sensitivity of urine cytology
  • Heterogeneous with small and large clusters of urothelial cells with enlarged nuclei, higher N/C ratio and a small nucleolus
  • Cells with a nucleolated globular body and variable slender cytoplasm are suggestive of low grade papillary urothelial carcinoma
  • Homogeneous cytoplasm, irregular nuclear membranes and increased N/C ratio are helpful criteria for diagnosis

High grade papillary urothelial carcinomas
  • See also high grade papillary
  • Clusters and single markedly atypical cells with pleomorphic nuclei, coarse chromatin and prominent nucleoli
  • Cells have abundant cytoplasm and may show vacuoles
  • Also irregular nuclear contours, coarse chromatin pattern and frequent nucleoli

Urothelial carcinoma in-situ (CIS)
  • See also carcinoma in situ
  • Cytology is a very important aid in diagnosis of CIS
  • Voided specimens from cases with CIS show clusters and single large pleomorphic cells showing marked atypia with hyperchromatic angulated nuclei, coarse chromatin, irregular nuclear contours and occasional prominent nucleoli
  • The N/C ratio is high and the cytoplasm is dense
  • Differential diagnosis: “decoy” cells (BK virus), degenerated cells, treatment effect: bCG or chemotherapy