Jewett A - tumor confined to the mucosa and submucosa. Jewett D - lymph node metastases. The natural history of transitional cell carcinoma is one of multiple recurrences over long periods of time, with a tendency for subsequent tumors to show greater anaplasia and to invade deeper. Recurrence rates increase with grade. Patients present with urinary frequency, dysuria or urgency.
Microscopic hematuria is very common but gross hematuria is present in an occasional patient.
The lesions are typically multifocal and are particularly common in patients with multiple or recurrent tumors in the bladder or elsewhere in the urinary tract. Foci are most frequent near tumors, but can occur in distant parts of the bladder. The gross appearances range from normal looking to granular, erythematous areas with no intraluminal projections. The histologic picture is that of an epithelium of variable thickness showing full-thickness cellular and architectural atypia in the form of nuclear pleomorphism and lack of maturation respectively. Compare the degree of pleomorphism with the normal transitional epithelium in the left panel.