Surgical Pathology Criteria

Papillary Urothelial (Transitional Cell) Carcinoma

Differential Diagnosis

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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