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Malignant tumors

Urothelial carcinomas

Reviewers: Sean Williamson, M.D. (see Reviewers page)
Revised: 21 February 2013, last major update June 2012
Copyright: (c) 2002-2013, PathologyOutlines.com, Inc.


● Urothelial carcinoma of renal pelvis and ureter often lumped together as “upper urinary tract”
● Most malignancies of ureter are urothelial carcinomas
● Most patients are women, age 50+, non-white
● Cause obstruction, may be multiple, occur concurrently in lower urinary tract
● Associated with smoking, occupational exposure to arylamines, analgesic nephropathy, Balkan nephropathy
● Also associated with hereditary nonpolyposis colorectal cancer syndrome (HNPCC/Lynch Syndrome, with mutations in DNA mismatch repair genes, detectable by microsatellite instability including MLH1, MSH2, MSH6, and PMS2); in contrast, bladder urothelial carcinoma is not clearly associated with HNPCC
● Associated with family history of colon cancer and higher grade urothelial carcinomas (Mod Pathol 2002;15:790)
● Overall 5-year survival (including renal pelvis) is 75%
● Tumor grade and stage are most important predictors of prognosis
● Low grade, noninvasive papillary urothelial carcinomas are monoclonal - multiple synchronous tumors appear to be due to intramucosal seeding (Hum Pathol 1999;30:1197)

Case reports

● 64 year old woman with HNPCC, colonic mucinous adenocarcinoma and ureteral noninvasive papillary urothelial carcinoma (Arch Pathol Lab Med 2003;127:E60)
● 75 year old woman with ulcerated mass - lymphoepithelioma-like carcinoma (Case of Week #267)
● 79 year old woman with micropapillary urothelial carcinoma (Arch Pathol Lab Med 2000;124:1347)


● Nephroureterectomy with excision of ipsilateral ureteral orifice and bladder cuff en bloc

Micro images

Urothelial papillary carcinoma
Various images of micropapillary variant of urothelial carcinoma
Case of the week #267:
Lymphoepithelioma-like carcinoma

Positive stains

● p63
● High molecular weight cytokeratin (may be helpful in distinguishing from renal neoplasms)
● Thrombomodulin (Am J Clin Pathol 1998;110:385)

Molecular image

Microsatellite analysis in a patient with microsatellite instability using 6 microsatellite markers. N indicates normal DNA; E, endometrial carcinoma; C, colon carcinoma; A, colon adenoma; and U, urothelial carcinoma

End of Ureters > Malignant tumors > Urothelial carcinomas

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