home   chapter home   jobs   conferences   fellowships   books     advertisement   bladder urothelial neoplasms-noninvasive high grade papillary urothelial carcinoma   reviewers: rugvedita parakh, md, cedars-sinai medical center (see reviewers page) revised: 22 september 2012, last major update - may 2010 copyright: (c) 2002-2012, pathologyoutlines. viagra sales usa secure canadian pharmacy online cheap viagra viagra coupon Com, inc. cheap viagra generic viagra without prescription   definition ========================================================================= ●  a neoplasm with urothelium lining papillary fronds, a predominant disorderly pattern and moderate to marked architectural and cytologic atypia ● icd-o: 8130/2 or /3   epidemiology ========================================================================= ● usually ages 50+, male (m:f = 6-8:1)   clinical features ========================================================================= ● gross or microscopic hematuria is common ● may invade adjacent structures or regional lymph nodes ● late dissemination to liver, lung, marrow ● grade 3 of 4 in ash system   prognostic factors ========================================================================= ● high rate (15-40%) of progression to invasive disease ● prognosis is better for pta (noninvasive) than pt1 (invasive into lamina propria) ( am j clin pathol 2010;133:788 )   treatment ========================================================================= ● transurethral resection and fulguration of visible tumor ● radical cystectomy, variable chemotherapy or radiation therapy ● in men, radical therapy includes cystoprostatectomy and excision of seminar vesicles ● in women, radical therapy includes excision of uterus, tubes, ovaries, anterior vagina, urethra ● ileal conduit is fashioned into a new bladder with reimplantation of ureters   clinical images =========================================================================   cystoscopy   gross description (macroscopy) ========================================================================= ● sessile or cauliflower-like with necrosis and ulceration ● exophytic papillary growth   gross images =========================================================================   multifocal papillary tumor   micro description (histopath. cost daily viagra nz viagra best results viagra generic viagra grapefruit side effects POPOMOMO