Urothelial carcinomas with variant divergent differentiation convey a worse prognosis than pure high-grade urothelial carcinoma. They remain unrecognized and underreported, despite their clinical and prognostic importance. They usually present with high pT stage and nodal metastasis. Treatment guidelines may also differ with aggressive multimodal therapy recommended in this setting. Keep abreast and apply scientific advances. Participants will learn to recognize the morphologic features of clinically significant variant/divergent histology in the urothelial tract, and the need to consistently report them due to their prognostic and therapeutic impact. We will discuss the differential diagnosis including the preneoplastic lesions and mimickers to ensure accurate recognition. We will also discuss the role of molecular advances in the diagnosis, classification, and management of urothelial carcinoma, including when and how to fully integrate such advances in routine diagnostic practice. The activity is suitable for both pathologists in training and in practice, irrespective of years of practice, in both academic and community settings.
This activity was originally presented at CAP22.
After completing this activity, you should be able to:
- Define variant/divergent differentiation according to the latest World Health Organization classification.
- Recognize and describe key variants of urothelial carcinoma and divergent differentiation, along with their potential diagnostic pitfalls and differential diagnosis.
- Understand the prognostic significance and therapeutic implications of variant/ divergent differentiation.
- Explain clinically relevant recent advances in the genomics of variant/divergent differentiation and how and when to incorporate them into daily practice.
Hikmat A. Al-Ahmadie, MD
Lara R. Harik, MD, FCAP
Accreditation: The College of American Pathologists (CAP) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.
CME Category 1: The College of American Pathologists designates this internet enduring material educational activity for a
maximum of 1.25
AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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College of American Pathologists
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This activity and evaluation are available March 6, 2023, and expire March 5, 2026, at 11:59 PM (CT). Upon completion of the activity your credit will be awarded. Your certificate may be downloaded from your Transcript.