Historically, terminology describing urinary tract lesions has been almost as confusing as lymphoma categories. A popular histologic grading system divides the neoplasms into three groups: Grade I (low), Grade II (medium), and Grade III (high). In those systems that add a fourth grade, equivalence may be accomplished by placing papillomas in the Grade I category, the low grade lesions in Grade II, etc. Including papillomas with Grade I lesions may be justified by the evidence that these benign appearing papil-lomas may progress to higher grade carcinomas, or at least identify the patient as at risk for subsequent development of a high grade lesion. From a patient management standpoint, all papillary lesions of the urinary bladder can be considered cancerous. However, the current general opinion, that the most treacherous lesions are the high grade sessile (flat) lesions, capable of quickly invading, makes the low grade papillary lesions less noteworthy than previously considered. Therefore, cytopathologists may prefer to divide the neoplasms of the urothelium simply into low and high grade.
3. Grading Urothelial Neoplasms Table 3. The WHO/ISUP Consensus Classification
May include cases formerly diagnosed as "mild dysplasia" Hyperplasia Flat hyperplasia Papillary hyperplasia Flat lesions with atypia
Reactive (inflammatory) atypia Atypia of unknown significance Dysplasia (low grade intraurothelial neoplasia) Carcinoma in situ (high grade intraurothelial neoplasia) Papillary neoplasms
Papillary neoplasm of low malignant potential (PUNLMP) Papillary carcinoma, low grade Papillary carcinoma, high grade Invasive neoplasms
Lamina propria invasion
Muscularis propria (detrusor muscle) invasion
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