Muscularis propria involvement is significant and should be evaluated carefully. Muscularis mucosae is variable and its involvement does not affect staging.If possible, the extent of lamina propria / submucosa invasion should be reported.Although non-invasive papillary urothelial neoplasms are technically in situ, they are staged as Ta and are not referred to as carcinoma in situ.Usual rules apply, but the report should make clear the poor prognosis even if muscularis propria involvement cannot be demonstrated.Micropapillary carcinoma is definitionally high grade.Spaces generally do not conform to shape of nests Invasive Urothelial Carcinoma with Prominent Retraction Artifact D240 stain can distinguish retraction from lymphatic invasion but ii not really necessary for clinical decisionsÄifferential Diagnosis Micropapillary Variant, Urothelial Carcinoma.Original posting/updates: 10/20/12 Supplemental studies Immunohistology Metastases retain the micropapillary pattern.Overlying surface may show usual urothelial carcinoma in situ, papillary carcinoma or micropapillary carcinoma.Large vacuole with surrounding cells may produce ring forms.In such cases, the report should comment on the poor prognosis and high probability of undetected spread.Muscularis propria involvement is generally assumed to be present even if not demonstrable in the specimens received.Frequently little or no stromal response.Cancer appears to melt through the muscularis propria.Agressive, permeative invasion is characteristic.Focal intracytoplasmic mucin may be present.Frequently multiple clusters in the same retraction space.Simulates lymphatic involvement, whis is frequently present too.Prominent retraction produces spaces around clusters.Mean width of clusters Primarily defined by pattern of invasion.Even small foci are associated with poor prognosis.Any component of micropapillary pattern should be reflected in the diagnosis.Usual papillary urothelial carcinoma is covered separately.Aggressive subtype of urothelial neoplasm that invades as small clusters of cells.Micropapillary Urothelial (Transitional Cell) Carcinoma Definition
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