Papillary urothelial neoplasm of low malignant potential

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PUNLMP (Papillary Urothelial Neoplasm of Low Malignant Potential)
File:Punlmp2.jpg
Micrograph of a PUNLMP. Intermediate magnification. H&E stain.
SpecialtyUrology, pathology

Papillary urothelial neoplasm of low malignant potential (PUNLMP) is an exophytic (outward growing), (microscopically) nipple-shaped (or papillary) pre-malignant growth of the lining of the upper genitourinary tract (the urothelium), which includes the renal pelvis, ureters, urinary bladder and part of the urethra.

PUNLMP is pronounced pun-lump, like the words pun and lump.

As their name suggests, PUNLMPs are neoplasms, i.e. clonal cellular proliferations, that are thought to have a low probability of developing into urothelial cancer, i.e. a malignancy such as bladder cancer.

Signs and symptoms

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PUNLMPs can lead to blood in the urine (hematuria) or may be asymptomatic.[citation needed]

Diagnosis

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File:Punlmp1.jpg
Micrograph of a PUNLMP showing characteristic features (see text). H&E stain.

PUNLMPs are exophytic lesions that appear friable to the naked eye and when imaged during cystoscopy. They are definitively diagnosed after removal by microscopic examination by pathologists.[citation needed]

Histologically, they have a papillary architecture with slender fibro vascular cores and rare basal mitoses. The papillae rarely fuse and uncommonly branch. Cytologically, they have uniform nuclear enlargement.[citation needed]

They cannot be reliably differentiated from low grade papillary urothelial carcinomas using cytology,[1] and their diagnosis (vis-a-vis low grade papillary urothelial carcinoma) has a poor inter-rater reliability.[2]

Pathologic grading and staging tumors are: graded by the degree of cellular atypia (G1->G3), and staged:[citation needed]

  • papilloma
  • papillary tumor of low malignant potential (PTLMP)
  • papillary urothelial carcinomas low grade
  • papillary urothelial carcinomas high grade.

Differential diagnosis

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File:Expression of p53 in urothelial neoplasms.png
Immunohistochemistry for p53 can help distinguish a PUNLMP from a low grade urothelial carcinoma. Overexpression is seen in 75% of low-grade urothelial carcinomas and only 10% of PUNLMP.[3][4]
  • Papilloma.
  • Low grade papillary urothelial carcinoma.

Treatment

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PUNLMPs are treated like non-invasive low grade papillary urothelial carcinomas,[1] excision and regular follow-up cystoscopies.

There is a rare occurrence of a pelvic recurrence of a low-grade superficial TCC after cystectomy. Delayed presentation with recurrent low-grade urothelial carcinoma is an unusual entity and potential mechanism of traumatic implantation should be considered. Characteristically low-grade tumors are resistant to systemic chemotherapy and curative-intent surgical resection of the tumor should be considered.[citation needed]

References

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  1. ^ a b Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  2. ^ Lua error in Module:Citation/CS1/Configuration at line 2172: attempt to index field '?' (a nil value).
  3. ^ Image is taken from following source, with some modification by Mikael Häggström, MD:
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  4. ^ Source for role in distinguishing PUNLMP from low-grade carcinoma:
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