By Jonathan I. Epstein
A bound-in CD-ROM includes over 800 full-color images masking the total spectrum of universal and infrequent lesions, and incorporates a quiz mode that's perfect for board examination preparation.
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PUNLMPs at low power differ from papillomas by having thicker urothelium. Otherwise, there are no architectural abnormalities, because the lesion has no loss of polarity (presence of order). Cytologically, PUNLMPs have a monotonous appearance, with each cell being virtually identical to each other. At most, nuclei are slightly enlarged and more crowded relative to those in normal urothelial nuclei. Nuclear grooves, a feature of normal urothelium, may be seen in these tumors and in papillomas, but not in higher grade lesions.
29. Denuded urothelium with carcinoma in situ within von Brunn nests. unsuspecting of invasive disease on the basis of cystoscopic evaluation, and the pathologist may fail to recognize single cell invasion or small clusters of invasion that may be camouflaged by background inflammation. Desmoplasia or retraction artifact is useful in recognizing invasion, but a stromal response may be absent (5,25). Polyomavirus Infection Infection of immunocompromised patients with the human polyomavirus, usually a nonpathogenic virus, results in large homogeneous inclusions in enlarged nuclei of urothelial cells, or “decoy cells” (see Chapter 10).
Carcinoma in situ with prominent nucleoli. FLAT UROTHELIAL LESIONS 25 retain abundant eosinophilic cytoplasm. The neoplastic cells in other examples of CIS may be monomorphic (large cell CIS without pleomorphism) (Fig. 18). These lesions may mimic reactive urothelial atypia because of the uniformity of the cells with conspicuous eosinophilic cytoplasm; however, they have markedly enlarged nuclei with high-grade cytologic features diagnostic of CIS. Small cell CIS has nuclear features identical to large cell CIS without pleomorphism, but it has scant cytoplasm (Fig.