Varinot J, Colin P, Rouprêt M, Leroy X, Comperat E
Service d'anatomopathologie, hôpital de la Pitié-Salpêtrière, AP-HP, 75013 Paris, France.
Service d'urologie, hôpital privé de la Louvière, générale de santé, 59000 Lille, France; Service d'urologie, hôpital de Seclin, rue d'Apolda, 59113 Seclin, France.
Prog Urol. 2014 Nov;24(15):954-65. doi: 10.1016/j.purol.2014.07.003. Epub 2014 Sep 8.
Upper tract urothelial carcinomas (UTUC) are rare tumors. Pathologist have a crucial role in establishing the diagnosis and the evaluation of the prognosis of these tumors.
A systematic review of the scientific literature was performed in the Medline database (PubMed) using different associations of the following key words alone or concomittantly: ureter; renal pelvis; urothelial carcinoma; specimen; pathology; histology; classification; grade; stage; prognosis. A particular search was done on the characteristics of the specimen management provided by urologists to pathologists and main prognostic specificities expected in UTUCs.
Urinary cytology and biopsies are useful to provide the grade of the tumor according to the WHO classification 2004. The urologist needs to depict the clinical context to the pathologist in order to eliminate differential diagnosis. The main prognostic informations provided by the pathologist from the specimen analysis are the following: stage (TNM 2009), grade (WHO 2004), carcinoma in situ, location within upper tract, multifocality, necrosis, tumor size, lymphovascular invasion, margins and potentially microsatellite status when a HNPCC case is suspected.
The pathologic analysis of a UTUC specimen needs nowadays to fulfill standardised international criteria of quality. However, specific additional aspects reported in the literature (e.g., lymphovascular invasion) are not systematically depicted.
上尿路尿路上皮癌（UTUC）是罕见肿瘤。病理学家在这些肿瘤的诊断确立及预后评估中发挥着关键作用。
在Medline数据库（PubMed）中对科学文献进行系统回顾，单独或同时使用以下关键词的不同组合：输尿管；肾盂；尿路上皮癌；标本；病理学；组织学；分类；分级；分期；预后。特别针对泌尿外科医生向病理学家提供的标本处理特征以及UTUC预期的主要预后特异性进行了检索。
根据2004年世界卫生组织分类，尿液细胞学检查和活检有助于确定肿瘤分级。泌尿外科医生需要向病理学家描述临床背景以排除鉴别诊断。病理学家通过标本分析提供的主要预后信息如下：分期（2009年TNM分期）、分级（2004年世界卫生组织分级）、原位癌、上尿路内位置、多灶性、坏死、肿瘤大小、淋巴管侵犯、切缘，以及在怀疑为遗传性非息肉病性结直肠癌（HNPCC）病例时可能的微卫星状态。
如今，UTUC标本的病理分析需要符合标准化的国际质量标准。然而，文献中报道的特定其他方面（如淋巴管侵犯）并未得到系统描述。
