Tumours of the Lower Urinary Tract

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Tumours of the lower urinary tract are derived from the transitional cells of the urothelium

Most tumours of the lower urinary tract arise from transitional-cell epithelium and are mainly caused by environmental agents excreted in high concentration in the urine. A field change takes place in the whole of the 
urothelium, such that all areas, from renal pelvis to urethra, are at risk of development of neoplasia. For this reason, multiple tumours are common. Transitional-cell tumours are most common in men, but are also fairly common in women.

The majority of tumours derived from the transitional-cell epithelium occur in the bladder and have a papillary growth pattern (papillary transitional-cell carcinomas). The epithelium covering the papillae can vary from histologically bland (low grade) to cytologically abnormal (moderate grade). All papillary transitional-cell tumours are regarded as carcinomas, regardless of how bland the epithelium appears on histological examination. Transitional-cell carcinomas exhibiting severe cytological abnormalities (high grade) tend not to have a papillary pattern, growing as solid, ulcerating lesions instead. It is well documented 
that patients can start with a low-grade tumour which, over time, develops progressive cytological atypia and turns into a high-grade tumour. 

A papillary transitional-cell carcinoma is seen arising from the dome of the bladder 
(a) as a fronded cauliflower-like lesion. Histologically 
(b), lesions are composed of papillae covered with transitional epithelium.

Squamous cell carcinoma & adenocarcinoma of the bladder are uncommon

Transitional-cell carcinomas in the renal pelvis, ureter and urethra are histologicaly similar in nature to those seen in 
the bladder. Importantly, following on from the concept of a field change seen in transitional-cell neoplasia, a patient who has had a tumour in one site is at risk of developing a second tumour in another site in the urothelium.

Papillary transitional cell carcinoma fills the renal pelvis with dilatation of the renal calyces caused by urinary obstruction.
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