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Microscopic Features: The atypical squamous features in this inverted urothelial papilloma (IUP) raised concern but were deemed insufficient for the diagnosis of carcinoma. Some authors recommend that such cases should be best considered as urothelial carcinomas with an inverted pattern. Others recommend calling them IUPs with a comment on the presence of atypia. In any case, close follow-up with periodic cystoscopic examination is recommended.