Department of Pathology, Norton Healthcare/CPA Lab, Louisville, KY.
Department of Pathology, Indiana University School of Medicine, Indianapolis, IN; Department of Urology, Indiana University School of Medicine, Indianapolis, IN.
Urol Oncol. 2021 May;39(5):286-290. doi: 10.1016/j.urolonc.2020.12.007. Epub 2021 Jan 1.
Papillary urothelial neoplasm of low malignant potential (PUNLMP) terminology remains controversial given its reported recurrence rate, its low interobserver diagnostic reproducibility, and its morphologic and molecular genetic overlap with low-grade noninvasive papillary urothelial carcinoma. By contrast, referring to any noninvasive tumor as a "carcinoma" is also controversial. PUNLMP and low-grade noninvasive papillary urothelial carcinomas cannot be reliably distinguished from one another even by experienced pathologists. As both tumors are treated in an identical manner and have similar rates of recurrence and progression, attempting to make this distinction is unnecessary and of little clinical value. These tumor types should therefore be combined into a single category for grading purposes. We propose that all tumors currently classified as either PUNLMP or low-grade noninvasive papillary urothelial carcinoma be termed low-grade noninvasive papillary urothelial neoplasms (NIPUN). This could improve interobserver reproducibility without sacrificing the prognostic utility of histologic grading. PUNLMP terminology should be discontinued and the term "carcinoma" should be reserved only for tumors showing histologic evidence of invasion.
低恶性潜能的乳头状尿路上皮肿瘤（PUNLMP）的术语仍然存在争议，因为其报道的复发率、观察者间诊断重复性低，以及其形态学和分子遗传学与低级别非浸润性乳头状尿路上皮癌重叠。相比之下，将任何非浸润性肿瘤称为“癌”也是有争议的。即使是有经验的病理学家也很难可靠地区分 PUNLMP 和低级别非浸润性乳头状尿路上皮癌。由于这两种肿瘤的治疗方式相同，且具有相似的复发和进展率，因此试图做出这种区分是不必要的，也没有什么临床价值。因此，这些肿瘤类型应合并为一个单一的分级类别。我们建议，所有目前被归类为 PUNLMP 或低级别非浸润性乳头状尿路上皮癌的肿瘤都应称为低级别非浸润性乳头状尿路上皮肿瘤（NIPUN）。这可以提高观察者间的重复性，而不牺牲组织学分级的预后效用。应停止使用 PUNLMP 术语，“癌”一词应仅保留用于显示组织学浸润证据的肿瘤。
