Surgical Pathology Criteria–

Papillary Urothelial (Transitional Cell) Carcinoma

Differential Diagnosis

Summary of differences, see Criteria page for details

Papillary Hyperplasia	Papilloma	PUNLUMP	Low Grade Ca	High Grade Ca
Undulating, no true papillae, bland	Papillae lining normal thickness, no atypia	Lining thicker than normal, atypia absent to minimal, rare mitoses	Orderly maturation, mild atypia, scattered mitoses and atypical nuclei	Disorderly, marked atypia, pleomorphism, frequent mitoses

Nephrogenic adenoma
Polypoid/papillary cystitis
Fibroepithelial polyp
Florid von Brunn nests
Florid cystitis cystica/glandularis

Nephrogenic Adenoma	Urothelial Papilloma
Papillae lined by single layer of cells, frequently hobnailed	Papillae lined by normal multilayered transitional epithelium
No umbrella cells	Normal umbrella cells present
Usually associated with tubular submucosal component	No associated tubular component

Papillary Urothelial Neoplasms	Papillary / Polypoid Cystitis
Delicate papillary stalks	Broad, edematous base and stalks
Lining may be atypical	Lined by normal urothelium
Frequent branching papillae	Broad fronds, little branching

Papillary Urothelial Neoplasms	Fibroepithelial Polyp
Delicate papillary stalks	Broad, fibrous base and stalks
Lining may be atypical	Lined by normal urothelium

Invasive Urothelial Carcinoma	Florid von Brunn Nests, Cystitis Cystica/Glandularis
Single cell invasion	Intact nests only
Jagged, irregular nests	Round regular nests
Mitotic figures and atypia present, appropriate to grade	No mitotic figures or atypia
Stroma may be desmoplastic	No stromal response

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