Malmstrom et al developed a grading classification for urothelial carcinomas of the urinary bladder. Jarkrans et al developed a simple flow diagram to classify a patient's tumor based upon this classification.
Grading Scheme of Malmstrom et al
|
Grade |
Features |
|
1 |
papillary or slightly papillary pattern; cell layer more than 5 cells thick; slight nuclear atypia and enlargement; occasional mitoses in the basal layer; there is normal differentiation into superficial cells; referred to as an atypical papilloma |
|
2A |
more pronounced nuclear atypia with variation in nuclear staining density and coarser chromatin; mitoses in lower half of the urothelium; overall pattern still shows a well-organized structure; differentiation into superficial cells occurs but less easily recognized; referred to as well-differentiated urothelial carcinoma |
|
2B |
overall pattern shows dominance of disorder but focal order present; mitoses more frequent and extend across entire urothelium; tumor can still be recognized as urothelial and/or papillary; differentiation into superficial cells very rare; referred to as a moderately differentiated urothelial carcinoma |
|
3 - 4 |
more pronounced expression of disorder with extreme variation in histologic features; mitoses are numerous; referred to as poorly differentiated urothelial carcinomas |
The algorithm of Jarkrans et al asks 2 questions:
(1) Is there a predominant order to the tumor?
(2a) (If there is predominant order) Is variation readily seen?
(2b) (If order is not predominant) Is focal order seen?
|
Predominant Pattern |
Additional Feature |
Grade |
|
order |
little variation |
Grade 1 |
|
order |
variation readily seen |
Grade 2A |
|
disorder |
focal order present |
Grade 2B |
|
disorder |
no order at all |
Grade 3-4 |
Specialty: Hematology Oncology, Surgery, general, Urology
