Papillary Urothelial Neoplasm of Low Malignant Potential: Evolving Terminology and Concepts

Timothy D. Jones, Liang Cheng

Research output: Contribution to journalReview article

63 Scopus citations


Purpose: The most controversial aspect of the new WHO 2004/ISUP classification system is the creation of the PUNLMP diagnostic category. We discuss PUNLMP tumors and the WHO 2004/ISUP classification system with an emphasis on tumor morphology and heterogeneity, recurrence and progression rates, tumor genetics, interobserver variability and the usefulness of biomarkers and molecular diagnostic techniques for grading bladder tumors. Materials and Methods: A literature search using PubMed was performed. All relevant literature concerning PUNLMP and the WHO 2004/ISUP grading system for urothelial neoplasms was reviewed. Results: The new WHO 2004/ISUP classification reflects work in progress. Low malignant potential terminology may not reflect the true biological behavior of these tumors. Additionally, interobserver variability in making a diagnosis of PUNLMP is high despite detailed histological criteria. Urine cytopathology in the context of the WHO 2004/ISUP classification does not appear to effectively discriminate PUNLMP from low grade carcinoma. Conclusions: For practical purposes patients with PUNLMP should be treated similarly to patients with low grade, noninvasive urothelial carcinoma. It is our hope that recent advances in the molecular grading of these tumors may eventually supplant traditional morphological classification, allowing a more precise and objective assessment of the biological potential of these tumors.

Original languageEnglish (US)
Pages (from-to)1995-2003
Number of pages9
JournalJournal of Urology
Issue number6
StatePublished - Jun 1 2006


  • bladder
  • bladder neoplasms
  • carcinoma
  • classification
  • papillary
  • urothelium

ASJC Scopus subject areas

  • Urology

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