A comparison of the pathology of transitional cell carcinoma of the bladder and upper urinary tract.
OBJECTIVE
To clarify the histopathological patterns of upper and lower urinary tract transitional cell carcinomas (TCCs), as previous reports suggest that upper urinary tract TCCs have a greater tendency towards high-grade disease than bladder TCCs, of which most are low-grade and low-stage tumours.


METHODS
All patients presenting with TCC of bladder or upper urinary tract between February 1991 and December 2001 at one institution were identified. Further patient information was obtained from the hospital database and case-note review.


RESULTS
In all, 164 patients with upper urinary tract TCC and 2197 with bladder TCC were identified. There was a correlation between grade and stage of both upper urinary tract and bladder TCCs. 35% of the upper tract TCCs were classified as grade 2 and 44% as grade 3, while for bladder TCCs, 31% of lesions were classified as grade 2 and 35% as grade 3 (P = 0.003). Of the upper urinary tract lesions 33% were stage pT2-T4, compared with only 20% of bladder TCCs (P = 0.001).


CONCLUSIONS
Upper urinary tract TCC is a higher grade and stage disease than bladder cancer, a finding that emphasizes the need for aggressive treatment of upper urinary tract TCC. If endourological management of upper urinary tract TCC is considered, histopathological determination of tumour grade before treatment is essential.
Stewart
Grant D
GD
Department of Urology, Western General Hospital, Edinburgh, EH4 2XU, UK.
Bariol
Simon V
SV
Grigor
Ken M
KM
Tolley
David A
DA
McNeill
S Alan
SA
D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology*; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000473:pathology*; D008297:Male; D011446:Prospective Studies; D014516:Ureteral Neoplasms / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology*