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- 90 percent of lesions are TCC, 5-9 percent of lesions squamous cell and 1-2 percent of lesions adenocarcinoma. Primary TCC with metaplastic elements is not uncommon. Cytologic grade adds some independent prognostic information by interpretation on a 1-3 scale is less uniform. Tumor stage is the predominant factor in prognostic outcome.
- Epithelial dysplasia. Dysplasia exhibits irregular urothelial and nuclear changes in a gradation toward carcinoma. High-grade dysplasia is difficult to distinguish from CIS. This is distinct from atypia, which is defined as an increase in cell layer number without changes in tissue structure or nuclear appearance.
- Carcinoma in situ. Similar to high grade dysplasia, yet lacks polarity and cell adhesion. Probable progenitor of muscle invasive disease.
- Superficial disease Papillary or nodular lesions confined to the mucosa [Ta] constitute true superficial disease. Lesions invading the lamina propria [T1] have a significantly higher chance of recurrence and progression [30-40 percent]. They require aggressive treatment and close observation.
- Muscle invasive disease. True involvement of the detrusor which can appear nodular or tentacular. Generally all of high cytologic grade.
- Squamous cell. Secondary to chronic irritation. Stone disease and chronic cathers as well as schistosomiasis infection.
- Adenocarcinoma. Rare lesions. Likely urarchal origin when at bladder dome. Must rule out metastatic deposit from another primary site such as breast or colon.
- Sarcoma. Rare in adults. Embryonal rhabdomyosarcoma seen in infants and young children.
- Small cell carcinoma. Rare lesions with neuroendocrine features. Generally very aggressive clinical course.
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Bladder Cancer 
